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

Nam, Karam; Jeon, Yunseok; Jung, Da Eun; Kwon, Seok Min; Kang, Pyoyoon; Cho, Youn Joung; Kim, Tae Kyoung

doi:10.1007/s12630-019-01349-0

Cited by 20 publications

(9 citation statements)

References 37 publications

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“…The accuracy of HbA1c is affected by the patient's anemia, hemoglobin variants, and so on [Ang 2015;Nitin 2010;Weykamp 2013]. Recently, some studies reported that other indicators, such as TIR, GV, GA, TyG, and others show good predictive value for renal complications [Yoo 2017;Saik 2020;Ding 2013;Clement 2019;Nam 2019;Varghese 2021;Qin 2020]. The preoperative HbA1c level only represents the patient's preoperative blood glucose.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Preoperative and Postoperative Glycemic Control on Acute Kidney Injury After Off-Pump Coronary Artery Bypass Grafting: A Case-Control Study

Wei

Zhang

Wang

et al. 2022

HSF

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Background: Acute kidney injury (AKI) is a common complication after cardiac surgery. It is closely related to poor perioperative glycemic control. We aimed to explore the relationship between preoperative hemoglobin A1c (HbA1c) levels and cumulative postoperative insulin usage and AKI after off-pump coronary artery bypass grafting (OPCABG). Method: The included a total of 284 patients undergoing isolated OPCABG from 2018 to 2020. According to KDIGO's diagnostic criteria, patients were divided into the AKI group and the non-AKI group. Methods included ① increase in SCr by ≥0.3 mg/dl (≥26.5 µmol/l) within 48 hours; ② increase in SCr to ≥1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; ③ urine volume <0.5 ml/kg/hour for 6 hours. Results: Fifty-one patients (17.9%) had postoperative AKI. HbA1c levels (non-AKI group 6.1 (5.8, 7.1) vs. the AKI group 7.1 (5.9, 8.6) (P = 0.014, cut-off=7.2, AUC=0.61, sensitivity 49%, specificity 76.4%) and postoperative insulin usage (non-AKI group 16.0 (4.0, 36.0) vs. the AKI group 56.0 (11.0, 132.0), P < 0.001, cut-off=39.5, AUC=0.673, sensitivity 60.8%, specificity 76.8%) were different between the two groups. Multivariate logistic regression analysis showed that HbA1c > 7.2% (OR=2.869, P = 0.04) and postoperative insulin usage > 39.5 U (OR=7.548, P < 0.001) were independently associated with AKI. Conclusions: HbA1c levels and cumulative postoperative insulin usage could be used as independent predictors for AKI after OPCABG. Postoperative insulin usage is more predictive than preoperative HbA1c levels.

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Section: Discussionmentioning

confidence: 99%

The Effect of Preoperative and Postoperative Glycemic Control on Acute Kidney Injury After Off-Pump Coronary Artery Bypass Grafting: A Case-Control Study

Wei

Zhang

Wang

et al. 2022

HSF

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“…59 Nam et al found intraoperative glucose variability, but not the average glucose concentration itself, as a risk factor for acute kidney injury (AKI) after cardiac surgery. 60 The impact of admission hyperglycemia on development of AKI in patients with AMI was found by Moriyama et al 61 Hence, a fair amount of literature exists, discussing the significance of glycemic management in cardiac critically ill patients and the complications arising out of episodes of DG. However, when it comes to nutrition intervention for managing DG, the literature is scarce.…”

Section: Cardiac Patientsmentioning

confidence: 98%

Practice Guidelines for Enteral Nutrition Management in Dysglycemic Critically Ill Patients: A Relook for Indian Scenario

Mehta

Mithal

Kulkarni

et al. 2019

Indian Journal of Critical Care Medicine

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Background and aim: Intensive-care practices and settings differ for India in comparison to other countries. While guidelines are available to direct the use of enteral nutrition (EN), there are no recommendations specific to nutritional management of EN in dysglycemic patients, specific to patients in Indian critical care settings. Advisory board meetings were arranged to develop the practice guidelines specific to the Indian context, for the use of EN in dysglycemic critically ill patients and to overcome challenges in this field. Materials and methods: Two advisory board meetings were organized to review various existing guidelines, meta-analyses, randomized controlled trials (RCTs), controlled trials and review articles, for their contextual relevance and strength. Three rounds of Delphi voting were done to arrive at consensus on certain recommendations. A systematic grading of practice guidelines by the advisory board was done based on strength of the consensus voting and reviewed supporting evidences. Results: Based on the literature review, the recommendations for developing the practice guidelines were made as per the grading criteria agreed upon by the advisory board. The recommendations were to address challenges regarding prediction and assessment of dysglycemia (DG), acceptable glycemic targets in such settings, general nutritional aspects pertaining to DG nutrition, and nutrition in various superspecialty cases in critical care settings, where DG is commonly encountered. Conclusion: This paper summarizes the optimum EN practices for managing DG in critically ill patients. The practical solutions to overcome the challenges in this field are presented as practice guidelines at the end of each section. These guidelines are expected to provide guidance for EN management in dysglycemic critically ill patients. These guidelines also outline the model glycemic control task force and its roles in nutrition care as well as an intensive care unit DG nutrition protocol.

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“…Furthermore, intraoperative GV may negatively influence the outcomes after cardiac surgery. Indeed, recent evidence recognized GV as an independent risk factor for early postoperative acute kidney injury [43]. In addition, for patients who underwent scheduled coronary artery bypass grafting (CABG) surgery, post-operative GV was associated with poor short-term outcomes, including increased risk of post-operative atrial fibrillation (AF), cardiac arrest, pneumonia, renal failure, stroke, sepsis, reoperation, and mortality [13,[44][45][46].…”

Section: Glycemic Variability and Stable Coronary Artery Diseasementioning

confidence: 99%

The Role of Glycemic Variability in Cardiovascular Disorders

Alfieri

Myasoedova

Vinci

et al. 2021

IJMS

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Diabetes mellitus (DM) is one of the most common and costly disorders that affect humans around the world. Recently, clinicians and scientists have focused their studies on the effects of glycemic variability (GV), which is especially associated with cardiovascular diseases. In healthy subjects, glycemia is a very stable parameter, while in poorly controlled DM patients, it oscillates greatly throughout the day and between days. Clinically, GV could be measured by different parameters, but there are no guidelines on standardized assessment. Nonetheless, DM patients with high GV experience worse cardiovascular disease outcomes. In vitro and in vivo studies showed that high GV causes several detrimental effects, such as increased oxidative stress, inflammation, and apoptosis linked to endothelial dysfunction. However, the evidence that treating GV is beneficial is still scanty. Clinical trials aiming to improve the diagnostic and prognostic accuracy of GV measurements correlated with cardiovascular outcomes are needed. The present review aims to evaluate the clinical link between high GV and cardiovascular diseases, taking into account the underlined biological mechanisms. A clear view of this challenge may be useful to standardize the clinical evaluation and to better identify treatments and strategies to counteract this DM aspect.

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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

Cited by 20 publications

References 37 publications

The Effect of Preoperative and Postoperative Glycemic Control on Acute Kidney Injury After Off-Pump Coronary Artery Bypass Grafting: A Case-Control Study

The Effect of Preoperative and Postoperative Glycemic Control on Acute Kidney Injury After Off-Pump Coronary Artery Bypass Grafting: A Case-Control Study

Practice Guidelines for Enteral Nutrition Management in Dysglycemic Critically Ill Patients: A Relook for Indian Scenario

The Role of Glycemic Variability in Cardiovascular Disorders

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