The effect of time between angiography and coronary artery bypass grafting on postoperative acute kidney injury in patients with diabetes mellitus

Abstract

Bu çalışmada diabetes mellituslu hastalarda koroner anjiyografi ve koroner arter baypas greftleme arasında geçen zamanın ameliyat sonrası akut böbrek hasarı üzerindeki etkisi araştırıldı. Ça lış ma pla nı:Aralık 2013 -Kasım 2016 tarihleri arasında koroner arter baypas greftleme yapılan toplam 421 hasta (274 erkek, 147 kadın; ort. yaş 60±9.2 yıl; dağılım 31-84 yıl) çalışmaya alındı. Hastaların demografik özellikleri, eşlik eden hastalıkları, tıbbi ve cerrahi öyküleri, daha önce yapılan koroner anjiyografileri ve cerrahi ve laboratuvar sonuçları dahil olmak üzere veriler retrospektif olarak incelendi. Hastalar akut böbrek hasarı olanlar (n=108) ve akut böbrek hasarı olmayanlar (n=313) olmak üzere iki gruba ayrıldı. Akut böbrek hasarı, Risk, Hasar, Yetmezlik, Kayıp, Son Dönem Böbrek Hastalığı (RIFLE) kriterlerine göre tanımlandı. Ayrıca hastalar zaman aralığına göre üç alt gruba ayrıldı: 0-3 gün, 4-7 gün ve >7 gün. Bul gu lar: Koroner anjiyografi ve koroner arter baypass greftleme arasında geçen medyan süre açısından akut böbrek hasarı olan ve olmayan hastalar arasında istatistiksel olarak anlamlı bir fark yoktu (sırasıyla, 11.5 ve 12.0 gün; p= 0.871). Akut böbrek hasarı risk faktörleri açısından alt gruplar arasında anlamlı bir fark yoktu. Çok değişkenli analizde geçirilmiş miyokard enfarktüsü (olasılık oranı [OR]: 5.192, %95 güven aralığı [GA]: 2.176-12.38; p<0.001) ve ameliyat sonrası birinci gün kreatinin düzeylerindeki artışın [OR: 4.102, %95 GA: 1.278-13.17; p= 0.018) akut böbrek hasarının bağımsız belirleyicileri olduğu bulundu. So nuç:Diabetes mellituslu hastalarda koroner anjiyografiden sonra, akut böbrek hasarı riskinde artış olmaksızın, herhangi bir gecikme olmadan koroner arter baypas greftleme yapılabilir. Anah tar söz cük ler: Akut böbrek hasarı; koroner anjiyografi; koroner arter baypas greftleme; diabetes mellitus.

What is the optimal time interval between heart catheterization and surgery to prevent acute kidney injury in patients with isolated coronary artery bypass?

“…Contrast-induced AKI is defined as the onset of acute renal failure within 2–7 days after administration of iodinated CM (most commonly after CAG and percutaneous coronary intervention), and it is one of the leading causes of acute renal failure during hospital stay [ 32 ]. The mechanism of CIN includes the direct toxic effect of contrast agents as well as contrast-induced vasospasm leading to decreased renal medullary blood flow; thus, this causes medullary ischaemia, increased reactive oxygen substrate formation, and oxidative stress [ 6 ]. Contrast agent-related risk factors for CIN include a high volume of contrast agents, the use of hyperosmolar contrast agents, repeated exposure to contrast agents within a short period, and intra-arterial administration of contrast agents [ 33 ].…”

“…The reason for this is that the contrast agents used in CAG and stress of CABG (double hit) may cause postoperative AKI in these patients [ 28 ]. Therefore, it has been suggested that it might be necessary to optimize the time interval between CAG and CABG to reduce the additive effect of contrast agents and surgery in patients undergoing CABG [ 6 ]. CI-AKI has been defined as the acute deterioration of renal function after contrast media administration in the absence of other causes [ 16 ].…”

“…Mariscalco et al reported that valve surgery and CABG increased the risk of AKI in the first 5 days after cardiac catheterization, but this increase was not seen in patients who underwent isolated CABG [ 38 ]. In their study, Doğan et al reported that CABG can be performed without any delay, without an increase in the risk of AKI, after CAG, in patients with diabetes mellitus [ 6 ].…”

“…Coronary angiography (CAG) using contrast agents is the gold standard method in the diagnosis and estimation of the prevalence of coronary artery disease (CAD) [ 6 ]. Contrast-induced nephropathy (CIN) is seen in up to 10% of patients with normal renal function, but this rate rises to 25% in patients with underlying renal dysfunction [ 7 ].…”

Investigation of the Effects of Stress Hyperglycemia Ratio and Preoperative Computed Tomographic Angiography on the Occurrence of Acute Kidney Injury in Diabetic Patients following Surgical Thromboembolectomy

“…In one study, it was shown that angiography increases the risk of renal damage in emergency trauma patients [ 3 ]. In another study, it was concluded that the time of angiography before coronary bypass did not affect postoperative renal failure in diabetic patients [ 4 ].…”