The Influence of Metabolic Syndrome on Acute Kidney Injury Occurrence after Coronary Artery Bypass Grafting
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
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.
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.
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).