The impact of diabetes mellitus on acute kidney injury after coronary artery bypass grafting
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(2020) 15:289
RESEARCH ARTICLE
Open Access
The impact of diabetes mellitus on acute kidney injury after coronary artery bypass grafting Rui Wang*†, Hang Zhang†, Yifan Zhu, Wen Chen and Xin Chen*
Abstract Background: Diabetes mellitus(DM) is an indicator affects postoperative mortality and morbidity after coronary artery bypass grafting (CABG). Acute kidney injury (AKI) is one of the frequent postoperative complications after CABG. This multi-centre register study designed to investigate the impact of DM on postoperative AKI in primary isolated CABG patients. Methods: We included all patients (n = 4325) from Jiangsu Province CABG register who underwent primary isolated CABG from September 2017 to August 2019. The patients were divided into 3 groups: No-DM group(n = 3067), DMoral group (DM with oral hypoglycemic agents, n = 706) and DM-insulin group (DM with insulin treatment, n = 552). The development and severity of AKI were based on Acute Kidney Injury Network (AKIN) criteria. Results: There were totally 338, 108 and 145 patients developed AKI in No-DM, DM-oral and DM-insulin group respectively. Comparing with No-DM group, DM-oral group had a higher rate of AKI(χ2 = 10.071, p = 0.002), DMinsulin group had a higher rate(χ2 = 94.042, p 0.3 mg/dL within 48 h; AKIN stage 2: increase creatinine × 2 from baseline; and AKIN stage 3: increase in creatinine × 3 from baseline or creatinine > 4 mg/dL with an acute increase > 0.5 mg/dL within 48 h or new-onset of dialysis therapy [13]. Study population
A standard set of perioperative data was collected prospectively for patients undergoing primary isolated CABG who were enrolled in Jiangsu province CABG register between January 2017 and December 2019. Patients undergoing a concomitant cardiac surgical procedure, reoperation, urgent or emergent operations, or with incomplete information were excluded. Totally there were 4325 cases up to the standard which were divided into 3 groups: No-DM group(n = 3067, 70.9%)), DM-oral group(DM with oral hypoglycemic agents, n = 706, 16.3%) and DM-insulin group(DM with insulin treatment, and with or without oral hypoglycemic agents, n = 552, 12.8%). On-pump CABG was performed via median sternotomy using a membrane oxygenator equipped with an arterial filter, cold blood antegrade cardioplegia under moderate systemic hypothermia (30 to 34 °C). The perfusion pressure during cardiopulmonary bypass(CPB) was maintained within 60–70 mmHg. Off-pump CABG was performed by a suction stabilizer. Good exposure of lateral vessels might be got by using deep pericardial retraction sutures. Visualization was enhanced by using a blower device. Intra-coronary shunt was used routinely. Average of perioperative blood sugar
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level was tried to be controlled under 150 mg/dl by oral hypoglycemic agents and/or insulin treatment. Twenty-one perioperative variables were collected including: age, gender, body mass index(BMI), eGFR, smoking, hypertension, DM and the type of treatment, hyperlipemia, chronic obstructive pulmonary disease(COPD), periphera
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