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Impact of intraoperative hyperglycaemia on renal dysfunction after off-pump coronary artery bypass

Jong Wook Song1, Jae Kwang Shim, Kyung Jong Yoo

  • 1Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea.

Interactive Cardiovascular and Thoracic Surgery
|May 22, 2013
PubMed
Abstract

Insights

High intraoperative glucose levels (>150 mg/dl) and glucose variability increase the risk of acute kidney injury (AKI) after off-pump coronary artery bypass graft (OPCAB) surgery. Tight glucose control below 110 mg/dl did not show additional AKI benefits.

Area of Science:

  • Cardiology
  • Nephrology
  • Anesthesiology

Background:

  • Acute kidney injury (AKI) is a common complication following off-pump coronary artery bypass graft (OPCAB) surgery.
  • Hyperglycemia is a significant risk factor for adverse outcomes and organ damage in cardiac surgery patients.

Purpose of the Study:

  • To investigate the association between intraoperative glucose levels and the incidence of postoperative AKI in OPCAB patients.
  • To identify specific glucose concentration thresholds and variability as independent risk factors for AKI.

Main Methods:

  • Retrospective review of 880 OPCAB patient records.
  • Patients categorized into three groups based on time-weighted average intraoperative glucose (<110, 110-150, >150 mg/dl).
  • Multivariate logistic regression used to determine independent risk factors for AKI.

Main Results:

  • AKI incidence was significantly higher in patients with glucose >150 mg/dl (8%) compared to those with glucose 110-150 mg/dl (3%).
  • Intraoperative glucose >150 mg/dl (OR 2.78), glucose variability (OR 1.04), and preoperative serum creatinine >1.4 mg/dl (OR 8.81) were independent risk factors for AKI.
  • No additional AKI benefit observed with intraoperative glucose control <110 mg/dl.

Conclusions:

  • Elevated intraoperative glucose concentrations (>150 mg/dl) and increased glucose variability are independently linked to AKI post-OPCAB.
  • Preoperative renal function is a critical determinant of AKI risk.
  • Current findings suggest focusing on avoiding hyperglycemia rather than strict tight control for AKI prevention in OPCAB.
Keywords:
Acute kidney injuryCoronary artery bypassHyperglycaemiaOff pump

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