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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
The Effects of Preoperative Volume Replacement in Diabetic Patients Undergoing Coronary Artery Bypass Grafting
Madeleine Clout1, Tracy Harris1, Chris Rogers1
1Bristol Cardiovascular, Faculty of Health Science, University of Bristol, Bristol, United Kingdom.
Insights
Preoperative volume replacement therapy (VRT) may reduce renal impairment in diabetic patients undergoing coronary artery bypass grafting (CABG). This study investigated VRT
Area of Science:
- Cardiology
- Nephrology
- Anesthesiology
Background:
- Diabetes mellitus increases risks for prolonged hospital stays, renal failure, and mortality after coronary artery bypass grafting (CABG).
- Preoperative renal impairment or volume depletion can worsen acute kidney injury in these patients.
- Preoperative volume replacement therapy (VRT) may improve glomerular filtration rate (GFR).
Purpose of the Study:
- To determine if preoperative VRT reduces postoperative complications in diabetic patients undergoing CABG.
- To assess the impact of VRT on time to discharge, renal failure incidence, and cardiac injury.
Main Methods:
- A randomized controlled trial involving 170 diabetic patients undergoing CABG.
- Intervention group received Hartmann's solution (1 mL/kg/hour for 12 hours pre-surgery); control group received routine care.
- Primary outcome: time to "fit for discharge"; secondary outcomes: renal failure, cardiac damage markers, inflammation, and hospital resource use.
Main Results:
- Study recruitment completed July 2014; data analysis commenced December 2016.
- Results are pending publication in summer 2017.
Conclusions:
- VRT is a simple intervention for surgical patients at risk of renal failure.
- This study will enhance understanding of VRT's efficacy in diabetic patients undergoing CABG.
- Positive findings could support widespread clinical implementation of VRT.
Background:
Diabetes mellitus is a major risk factor for prolonged hospital stays, renal failure, and mortality in patients having coronary artery bypass grafting (CABG). Complications pose a serious threat to patients and prolong intensive care and hospital stays. Low glomerular filtration rate (GFR) due to existing renal impairment or volume depletion may exacerbate acute renal impairment/failure in these patients. Preoperative volume replacement therapy (VRT) is reported to increase the GFR and we hypothesize that VRT will reduce renal impairment and related complications in diabetic patients.
Objective:
The objective of this study is to establish the efficacy of preoperative VRT in reducing postoperative complications in diabetic patients undergoing CABG surgery. Time to "fit for discharge", incidence of postoperative renal failure, cardiac injury, inflammation, and other health outcomes will be investigated.
Methods:
In this open parallel group randomized controlled trial, 170 diabetic patients undergoing elective or urgent CABG surgery received 1 mL/kg/hour of Hartmann's solution for 12 consecutive hours prior to surgery, versus routine care. The primary outcome was time until participants were "fit for discharge", which is defined as presence of: normal temperature, pulse, and respiration; normal oxygen saturation on air; normal bowel function; and physical mobility. Secondary outcomes included: incidence of renal failure; markers of renal function, inflammation, and cardiac damage; operative morbidity; intensive care stay; patient-assessed outcome, including the Coronary Revascularization Outcome Questionnaire; and use of hospital resources.
Results:
Recruitment started in July 2010. Enrolment for the study was completed in July 2014. Data analysis commenced in December 2016. Study results will be submitted for publication in the summer of 2017.
Conclusions:
VRT is a relatively easy treatment to administer in patients undergoing surgical procedures who are at risk of renal failure. This experimental protocol will increase scientific and clinical knowledge of VRT in diabetic patients undergoing elective or urgent CABG surgery. Findings supporting the efficacy of this intervention could easily be implemented in the health care system.
Trial Registration:
International Standard Randomized Controlled Trial Number (ISRCTN): 02159606; http://www.controlled-trials.com/ISRCTN02159606 (Archived by WebCite at http://www.webcitation.org/6rDkSSkkK).
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