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Intraoperative glucose variability, but not average glucose concentration, may be a risk factor for acute kidney injury after cardiac surgery: a retrospective study

  • Karam Nam
  • Yunseok Jeon
  • Won Ho Kim
  • Dhong Eun Jung
  • Seok Min Kwon
  • Pyoyoon Kang
  • Youn Joung Cho
  • Tae Kyong KimEmail author
Reports of Original Investigations

Abstract

Purpose

Altered perioperative glycemic control may contribute to the development of renal dysfunction in cardiac surgery patients. Nevertheless, whether it is intraoperative hyperglycemia or increased glucose variability that affects postoperative outcomes is not yet clear. The aim of this study was to assess the association of intraoperative glucose concentration and variability with acute kidney injury (AKI) after cardiac surgery.

Methods

We retrospectively reviewed the electronic medical records of 3,598 patients who underwent cardiac surgery between November 1, 2006 to December 31, 2016. The time-weighted average glucose (TWAG) and coefficient of variation of glucose measurements were both used as measures of intraoperative glucose control with multivariable logistic regression to evaluate their relationship to postoperative AKI.

Results

The intraoperative glucose coefficient of variation was an independent risk factor for AKI after cardiac surgery (highest quartile odds ratio, 1.38; 95% confidence interval, 1.09 to 1.75; P = 0.01). Nevertheless, the intraoperative TWAG did not remain in the final multivariable model of postoperative AKI.

Conclusion

Intraoperative glucose variability, but not the average glucose concentration itself, may be a risk factor for AKI after cardiac surgery.

La variabilité glycémique peropératoire, et non la concentration glycémique moyenne, pourrait être un facteur de risque d’insuffisance rénale aiguë après une chirurgie cardiaque: une étude rétrospective

Résumé

Objectif

Un contrôle glycémique périopératoire déficient pourrait contribuer à l’apparition d’une dysfonction rénale chez les patients de chirurgie cardiaque. Toutefois, nous ne savons pas si c’est une hyperglycémie peropératoire ou l’augmentation de la variabilité glycémique qui affecte les pronostics postopératoires. L’objectif de cette étude était d’évaluer l’association entre la concentration et la variabilité glycémiques peropératoires et l’insuffisance rénale aiguë (IRA) après une chirurgie cardiaque.

Méthode

Nous avons rétrospectivement passé en revue les dossiers médicaux électroniques de 3598 patients ayant subi une chirurgie cardiaque entre le 1er novembre 2006 et le 31 décembre 2016. La moyenne glycémique pondérée dans le temps et le coefficient de variation des mesures glycémiques ont été utilisés comme mesures de la régulation glycémique peropératoire, et la régression logistique multivariée a été utilisée pour évaluer leur relation à l’IRA postopératoire.

Résultats

Le coefficient de variation peropératoire de la glycémie était un facteur de risque indépendant d’IRA après une chirurgie cardiaque (rapport de cotes du quartile le plus élevé, 1,38; intervalle de confiance 95 %, 1,09 à 1,75; P = 0,01). Toutefois, la moyenne glycémique peropératoire pondérée dans le temps n’est pas demeurée dans le modèle multivarié final de l’IRA postopératoire.

Conclusion

La variabilité peropératoire de la glycémie, et non la concentration glycémique moyenne, pourrait être un facteur de risque d’IRA après une chirurgie cardiaque.

Notes

Conflict of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

Author contributions

Karam Nam contributed to the study design, data collection, analysis, and writing the paper. Yunseok Jeon contributed to the study design, writing the paper, and revising the paper. Won Ho Kim contributed to the study design, data analysis, and revising the paper. Dhong Eun Jung contributed to data collection, writing the paper, and revising the paper. Seok Min Kwon, Pyoyoon Kang and Youn Joung Cho contributed to data collection, data analysis, and revising the paper. Tae Kyong Kim contributed to study design/planning, data collection, data analysis, and revising the paper.

Funding

None declared.

Supplementary material

12630_2019_1349_MOESM1_ESM.pdf (92 kb)
Supplementary material 1 (PDF 91 kb)

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Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  1. 1.Department of Anesthesiology and Pain MedicineSeoul National University HospitalSeoulKorea
  2. 2.Department of Anesthesiology and Pain MedicineSMG-SNU Boramae Medical CenterSeoulKorea
  3. 3.Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical CenterSeoul National University College of MedicineSeoulKorea

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