The Influence of Metabolic Syndrome on Acute Kidney Injury Occurrence after Coronary Artery Bypass Grafting

  • Atike Tekeli Kunt Department of Cardiovascular Surgery, Kocaeli Derince Education and Research Hospital, Kocaeli
  • Hakan Parlar Department of Cardiovascular Surgery, Kocaeli Derince Education and Research Hospital, Kocaeli
  • Orhan Findik Department of Cardiovascular Surgery, Kocaeli Derince Education and Research Hospital, Kocaeli
  • Cagri Duzyol Department of Cardiovascular Surgery, Kocaeli Derince Education and Research Hospital, Kocaeli
  • Ozgur Baris Department of Cardiovascular Surgery, Kocaeli Derince Education and Research Hospital, Kocaeli
  • Canan Balci Department Anesthesiology, Kocaeli Derince Education and Research Hospital, Kocaeli

Abstract

Background: Metabolic syndrome (MetS) is defined as a cluster of systemic abnormalities: hyperglycemia, dyslipidemia, abdominal obesity, and hypertension. Acute kidney injury (AKI) is one of the devastating complications after cardiac surgery. Age, DM, preexisting renal dysfunction, hypertension, impaired left ventricular function, and severe arteriosclerosis of the aorta are the major risk factors for the development of AKI. The purpose of the current study was to analyze the influence of MetS on AKI occurring after coronary artery bypass grafting (CABG).

Methods: We retrospectively reviewed the prospectively collected data of 500 adult patients who underwent isolated CABG surgery with normal renal function (baseline serum creatinine value <1.4 mg/dL) from January 2011 to January 2015. The patients were divided into two groups either having the diagnosis of MetS (Group I) or not (Group II). MetS was diagnosed based on International Diabetes Federation definition. Kidney injury was interpreted according to RIFLE classification. The effect of MetS on AKI after CABG was determined using logistic regression analysis and the results were expressed as odds ratio (OR) with a 95% confidence interval (CI). A P value <.05 was considered
statistically significant.

Results: Metabolic syndrome was diagnosed in 16.4% of all patients. Postoperative AKI occurred in 26 patients (31.7%) in Group I whereas there were 53 patients (12.7%) in Group II. On logistic regression analysis, the presence of MetS was shown to be associated with increased incidence of postoperative AKI (OR, 3.197; 95% CI, 1.850-5.526;
P = .000).

Conclusion: The presence of MetS seems to be associated with increased incidence of AKI after cardiac surgery. MetS is a modifiable issue; if its components are well controlled its dreadful effects after cardiac surgery might be controlled as well.

References

Alberti KG, Zimmet P, Shaw J. 2005. The Metabolic Syndrome: a new worldwide definition. Lancet 366:1059-62.

Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. 2004. Acute Dialysis Quality Initiative workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8:R204-12.

Carson JL, Scholz PM, Chen AY, et al. 2002. Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am Coll Cardiol 40:418-23.

Chertow GM, Lazarus JM, Christiansen CL, et al. 1997. Preoperative renal risk stratification. Circulation 95:878-84.

Cockcroft DW, Gault MH. 1976. Prediction of creatinine clearance from serum creatinine. Nephron 16:31-41.

Despres JP. 2003. Inflammation and cardiovascular disease: is abdominal obesity the missing link? Int J Obes Metab Disord 27suppl:S22-24.

Doddakula K, Al-Sarraf N, Gately K, et al. 2007. Predictors of acute renal failure requiring renal replacement therapy post cardiac surgery in patients with preoperatively normal renal function. Interact Cardiovasc and Thorac Surg 6:314-18.

Echahidi N, Pibarot P, Despres JP, et al. 2007. Metabolic syndrome increases operative mortality in patients undergoing coronary artery bypass grafting surgery. J Am Coll Cardiol 50:843-51.

Glance LG, Wissler R, Mukamel DB, et al. 2010. Perioperative outcomes among patients with the modified metabolic syndrome who are undergoing noncardiac surgery. Anesthesiology 113:859-72.

Hall RI, Smith MS, Rocker G. 1997. The systemic inflammatory response to cardiopulmonary bypass: pathophysiological, therapeutic, and pharmacological considerations. Anesth Analg 85:766-82.

Hong S, Youn YN, Yoo KJ. 2010. Metabolic syndrome as a risk factor for postoperative kidney injury after off-pump coronary artery bypass surgery. Circ J 74:1121-6.

Kajimato K, Kasai T, Miyauchi K, et al. 2008. Metabolic syndrome predicts 10-year mortality in non-diabetic patients following coronary artery bypass surgery. Circ J 72:1481-6.

Kajimoto K, Miyauchi K, Kasai T, et al. 2009. Metabolic syndrome is an independent risk factor for stroke and acuterenal failure after coronary artery bypass grafting. J Thorac Cardiovasc Surg 137:658-63.

Kambham N, Markowitz GS, Valeri AM, Lin J, D’Agati VD. 2001. Obesity-related glomerulopathy: An emerging epidemic. Kidney Int 59:1498-1509.

Kurella M, Lo JC, Chertow GM. 2005. Metabolic syndrome and the risk for chronic kidney disease among nondiabetic adults. J Am Soc Nephrol 16:2134-40.

Lassnigg A, Donner E, Grubhofer G, Presterl E, Druml W, Hiesmayr M. 2000. Lack of renoprotective effects of dopamine and furosemide during cardiac surgery. J Am Soc Nephrol 11:97-104.

Mariam PA, Tejas VP, Youssef MK, Adriana F, Helmut GR, Ajay KS. 2009. Kidney pathological changes in metabolic syndrome: A crosssectional study. Am J Kidney Dis 53:751-9.

Mirmuhammad-Sadeghi M, Naghiloo A, Najarzadegan MR. 2013. Evaluating the relative frequency and predictors of acute renal failure following coronary artery bypass grafting. ARYA Atheroscler 9:287-92.

Pan W, Hindler K, Lee VV, Vaughn WK, Collard CD. 2006. Obesity in diabetic patients undergoing coronary artery bypass graft surgery is associated with increased postoperative morbidity. Anesthesiology 104:441-7.

Sprecher DL, Pearce GL. 2000. How deadly is the “deadly quertet?” A post-CABG evaluation. J Am Coll Cardiol 36:1159-65.

Suen WS, Mok CK, Chiu SW, et al. 1998. Risk factors for development of acute renal failure (ARF) requiring dialysis in patients undergoing cardiac surgery. Angiology 49:789-90.

Swart MJ, De Jager WH, Kemp JT, Nel PJ, Van Staden SL, Joubert G. 2012. The effect of the metabolic syndrome on the risk and outcome of coronary artery bypass graft surgery. Cardiovasc J Africa 23:400-4.

Uendo M, Kawashima S, Nishi S, et al. 1997. Tubulointerstitial lesions in non-insulin dependent diabetes mellitus. Kidney Int Suppl 63:S191-4.

Weerasinghe A, Hornick P, Smith P, Taylor K, Ratnatunga C. 2001. Coronary artery bypass grafting in non-dialysis-dependent mild-to-moderate renal dysfunction J Thorac Cardiovasc Surg 121:1083-9.

Published
2016-05-18
How to Cite
Tekeli Kunt, A., Parlar, H., Findik, O., Duzyol, C., Baris, O., & Balci, C. (2016). The Influence of Metabolic Syndrome on Acute Kidney Injury Occurrence after Coronary Artery Bypass Grafting. The Heart Surgery Forum, 19(3), E099-E103. https://doi.org/10.1532/hsf.1400
Section
Articles

Most read articles by the same author(s)