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Updated: Apr 12, 2026
A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
Chronic hyperglycemia is associated with acute kidney injury in patients undergoing CABG surgery--a cohort study
Mehmet Oezkur1, Martin Wagner2,3,4, Dirk Weismann5,6
1Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany. Oezkur_m@ukw.de.
Insights
Chronic hyperglycemia (CHG), indicated by HbA1c, is linked to acute kidney injury (AKI) after coronary artery bypass grafting (CABG). Measuring HbA1c may inform surgical decisions over a diabetes history alone.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Endocrinology
Background:
- Chronic hyperglycemia (CHG), indicated by HbA1c, is a known risk factor for adverse outcomes after coronary artery bypass grafting (CABG).
- Acute kidney injury (AKI) is a common and serious complication following CABG, impacting patient prognosis.
- The relationship between CHG and AKI in CABG patients, considering diabetes mellitus (DM) history, requires further investigation.
Purpose of the Study:
- To investigate the association between chronic hyperglycemia (CHG) and the incidence of postoperative acute kidney injury (AKI) in patients undergoing coronary artery bypass grafting (CABG).
- To compare the risk of AKI in CABG patients with and without a history of diabetes mellitus (DM) and CHG.
Main Methods:
- A cohort study included 307 patients undergoing CABG in 2009, excluding those with advanced chronic kidney disease (CKD).
- Chronic hyperglycemia (CHG) was defined as HbA1c ≥ 6.0%.
- Univariate and multivariate logistic regression analyses were used to determine the association between CHG and postoperative AKI.
Main Results:
- The overall incidence of AKI was 48.2%.
- Patients with CHG (n=165) exhibited higher rates of female sex, larger waist circumference, and more comorbidities, including smoking, DM history, CKD, hypertension, pulmonary hypertension, and COPD (p ≤ 0.05).
- Multivariate analysis identified age, CHG, and prolonged operative duration as independent predictors of postoperative AKI (p < 0.05).
Conclusions:
- Chronic hyperglycemia (CHG), identified by a single HbA1c measurement of ≥ 6.0%, is significantly associated with the incidence of AKI after CABG.
- HbA1c measurement may offer a more objective indicator than a documented diabetes history for assessing AKI risk and guiding treatment decisions in CABG patients.
- These findings suggest that preoperative HbA1c levels could be valuable in optimizing surgical strategies and patient management to mitigate AKI risk.
Background:
Chronic hyperglycemia (CHG) with HbA1c as an indicator affects postoperative mortality and morbidity after coronary artery bypass grafting surgery (CABG). Acute kidney injury (AKI) is one of the frequent postoperative complications after CABG impacting short-and long-term outcomes. We investigated the association between CHG and postoperative incidence of AKI in CABG patients with and without history of diabetes mellitus (DM).
Methods:
This cohort study consecutively enrolled patients undergoing CABG in 2009 at the department for cardiovascular surgery. CHG was defined as HbA1c ≥ 6.0%. Patients with advanced chronic kidney disease (CKD) were excluded. The incidence of postoperative AKI and its association with CHG was analyzed by univariate and multivariate logistic regression modeling.
Results:
Three-hundred-seven patients were analyzed. The incidence of AKI was 48.2%. Patients with CHG (n = 165) were more likely to be female and had greater waist circumference as well as other comorbid conditions, such as smoking, history of DM, CKD, hypertension, pulmonary hypertension, and chronic obstructive pulmonary disease (all p ≤ 0.05). Preoperative eGFR, atrial fibrillation (AF), history of DM and CHG were associated with an increased risk of postoperative AKI in univariate analyses. In multivariate modelling, history of DM as well as preoperative eGFR and AF lost significance, while age, CHG and prolonged OP duration (p < 0.05) were independently associated with postoperative AKI.
Conclusions:
Our results suggest that CHG defined on a single measurement of HbA1c ≥ 6.0% was associated with the incidence of AKI after CABG. This finding might implicate that treatment decisions, including the selection of operative strategies, could be based on HbA1c measurement rather than on a recorded history of diabetes.
