Tight perioperative glucose control is associated with a reduction in renal impairment and renal failure in non-diabetic cardiac surgical patients

Lecomte, P.; Vlem, Bruno Van; Coddens, J.; Cammu, Guy; Nollet, G.; Nobels, Frank; Vanermen, Hugo; Foubert, L.

doi:10.1186/cc7145

Cited by 85 publications

(58 citation statements)

References 37 publications

(42 reference statements)

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“…Nonetheless, some preoperative and intraoperative preventive actions may help to prevent the postoperative renal dysfunction. Postponing the operation to improve the hemodynamic situation [19], stopping medications, such as angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, shortly before the operation [20], planning the surgical strategy to shorten the cardiopulmonary bypass time, and a tight perioperative glucose control [21] may help to reduce the incidence of postoperative renal dysfunction. Nacetylcysteine, B-type natriuretic peptide and other drugs have been proposed to reduce postoperative AKI or improve the renal function, however their use has been controversial [4].…”

Section: Discussionmentioning

confidence: 99%

Fatores de risco para lesão renal aguda após cirurgia cardíaca

Rodrigues¹,

Évora²,

Bassetto³

et al. 2009

Rev Bras Cir Cardiovasc

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Fatores de risco para lesão renal aguda após cirurgia cardíacaRisk factors for acute kidney injury after cardiac surgery Abstract Objective: The objective of the present investigation was to identify risk factors for acute kidney injury in patients with normal levels of serum creatinine who underwent coronary artery bypass graft (CABG) surgery and/or valve surgery.Methods: Data from a cohort of 769 patients, after the exclusion criteria were applied, were analyzed using bivariate analyses and binary logistic regression modeling.Results: Three hundred eighty one patients experienced CABG, 339 valve surgery and 49 went through both simultaneously. Forty six percent of the patients were female and the mean age was 57±14 years (13 to 89 years). Seventy eight patients presented renal dysfunction postoperatively (10%), of these 23% needed hemodialysis (2.4% of all patients). The mortality for the whole cohort was 10%. The overall mortality for patients experiencing postoperative renal dysfunction was 40 % (versus 7%, P<0.001), 29% for those who did not need dialysis and 67% for those who needed dialysis (P=0.004). The risk factors that were independently associated with AKI were: age (P<0.000, OR: 1.056), congestive heart failure (P=0.

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Section: Discussionmentioning

confidence: 99%

Fatores de risco para lesão renal aguda após cirurgia cardíaca

Rodrigues¹,

Évora²,

Bassetto³

et al. 2009

Rev Bras Cir Cardiovasc

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“…The absence of a reduction in the need for RRT in medical patients could be explained by the higher illness severity with more renal dysfunction on admission, precluding an impact of this mainly protective intervention [185]. Two large sequential cohort studies, one in a medical-surgical ICU [186] and the other in the setting of cardiac surgery [187], also revealed a significant reduction in observed renal dysfunction after the implementation of tight glycemic control. Finally, a recent meta-analysis indicated that survival benefit by applying tight glycemic control, if any, may be restricted only to patients in surgical ICUs [188].…”

Section: Vasodilatorsmentioning

confidence: 99%

Prevention of acute kidney injury and protection of renal function in the intensive care unit

et al. 2009

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Background: Acute renal failure on the intensive care unit is associated with significant mortality and morbidity. Objectives: To determine recommendations for the prevention of acute kidney injury (AKI), focusing on the role of potential preventative maneuvers including volume expansion, diuretics, use of inotropes, vasopressors/vasodilators, hormonal interventions, nutrition, and extracorporeal techniques. Method: A systematic search of the literature was performed for studies using these potential protective agents in adult patients at risk for acute renal failure/kidney injury between 1966 and 2009. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, and use of potentially nephrotoxic drugs and radiocontrast media. Where possible the following endpoints were extracted: creatinine clearance, glomerular filtration rate, increase in serum creatinine, urine output, and markers of tubular injury. Clinical endpoints included the need for renal replacement therapy, length of stay, and mortality. Studies are graded according to the international Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) group system Conclusions and recommendations: Several measures are recommended, though none carries grade 1A. We recommend prompt resuscitation of the circulation with special attention to providing adequate hydration whilst avoiding high-molecular-weight hydroxy-ethyl starch (HES) preparations, maintaining adequate blood Intensive Care Med (2010) 36:392-411 DOI 10.1007/s00134-009-1678 EXPERT PANEL pressure using vasopressors in vasodilatory shock. We suggest using vasopressors in vasodilatory hypotension, specific vasodilators under strict hemodynamic control, sodium bicarbonate for emergency procedures administering contrast media, and periprocedural hemofiltration in severe chronic renal insufficiency undergoing coronary intervention.

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“…2,[7][8][9][10][11][12][20][21][22]24,25 The authors of the remaining four articles did not find statistically significant association between peri-operative hyperglycemia and patient mortality. 13,18,19,23 Table 1 summarizes the main characteristics of the reviewed articles for this study.…”

Section: Resultsmentioning

confidence: 87%

“…As mentioned above, out of 16 reviewed articles in our study, 2,7-13,18-25 12 have as their main finding the association of hyperglycemia and inadequate BG control with increased mortality rates, either in-hospital or within 30 days. 2,[7][8][9][10][11][12][20][21][22]24,25 In the remaining four articles 13,18,19,23 the investigators did not find a statistically significant correlation between perioperative hyperglycemia or/and poor glycemic control and patient mortality, although Lazar et al 13 observed a significant survival advantage over the initial 2 years after surgery for patients with tight peri-operative glucose control. In addition, we could find a point of great interest in the findings of the study by Gandhi et al,18 in which the authors not only did not observe a significant correlation between tight glucose control for normoglycemia and 30-day mortality, but also concluded that there was a statistically significant increase in the incidence of death in the intensive insulin treatment patient group.…”

Section: Discussionmentioning

confidence: 97%