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A prospective randomized study to evaluate the renal impact of surgical revascularization strategy in diabetic
Thomas Modine1, Costas Zannis, Julia Salleron
1Department of Cardiovascular Surgery, Centre Hospitalier Régional et Universitaire de Lille, Lille, France. t-modine@chru-lille.fr
Abstract:
Acute kidney injury (AKI) is a major postoperative complication following cardiac surgery. Diabetes mellitus is a major cause of nephropathy and end-stage renal failure. We aimed to evaluate the occurrence of adverse renal outcomes, in diabetic patients, between on-pump (CPB) and off-pump (OPCAB) coronary artery bypass graft (CABG). Seventy-one diabetic patients (36 and 35 patients in the CPB and OPCAB groups, respectively) were enrolled in a prospective randomized study. Renal tubular and glomerular functions, were monitored preoperatively and over five consecutive days. There was no significant difference between the groups in terms of age, gender, New York Heart Association class, Canadian Cardiovascular Society functional classification of angina grade and number of CABG. Intensive care unit stay, duration of intubation, hospital stay and bleeding were significantly higher in the CPB group. No significant differences in plasmatic creatinine, urinary creatinine, creatinine clearance, proteinuria or osmolality were detected. A significant rise in urinary albumine excretion occurred in both groups peaking on the operative day; for the on-pump CABG group (10±5 vs. 48±57; P=0.015) and for the OPCAB group (11±6 vs. 37±59; P=0.04). Values were less important in the OPCAB group and return to the baseline was faster than in the CPB group. OPCAB attenuates sub-clinical AKI, in diabetic patients.
Insights
Off-pump coronary artery bypass grafting (CABG) may attenuate sub-clinical acute kidney injury (AKI) in diabetic patients. While both on-pump and off-pump CABG showed increased urinary albumin, off-pump showed a faster return to baseline.
Area of Science:
- Nephrology
- Cardiovascular Surgery
- Diabetology
Background:
- Acute kidney injury (AKI) is a significant postoperative complication after cardiac surgery.
- Diabetes mellitus is a leading cause of kidney disease and end-stage renal failure.
- Diabetic patients undergoing coronary artery bypass graft (CABG) surgery face increased renal risks.
Purpose of the Study:
- To compare the incidence of adverse renal outcomes in diabetic patients undergoing on-pump (CPB) versus off-pump (OPCAB) CABG.
- To evaluate the impact of CPB and OPCAB on renal function in diabetic individuals.
Main Methods:
- A prospective randomized study involving 71 diabetic patients (36 CPB, 35 OPCAB).
- Monitoring of renal tubular and glomerular function preoperatively and for five days postoperatively.
- Assessment of plasmatic creatinine, urinary creatinine, creatinine clearance, proteinuria, and osmolality.
Main Results:
- No significant differences in baseline characteristics or major renal function markers (creatinine, clearance, proteinuria, osmolality) between groups.
- Both groups showed a significant rise in urinary albumin excretion postoperatively, peaking on the operative day.
- Urinary albumin excretion values were lower and returned to baseline faster in the OPCAB group compared to the CPB group.
Conclusions:
- Off-pump coronary artery bypass grafting (OPCAB) appears to attenuate sub-clinical acute kidney injury in diabetic patients.
- While both surgical methods affect renal function, OPCAB demonstrates a potentially protective effect with faster recovery of urinary albumin levels.
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