Evaluation of Early Postoperative Period Results of Patients With Type 2 Diabetes Taking Oral Anti-Diabetics Or Insulin Medications, With Microalbuminuria and Normal Creatinine Levels After Coronary Artery Bypass

Authors

  • Gemalmaz Huseyin, MD Prof. Dr. Cemil Tascıoglu City Hospital, Cardiovascular Surgery Clinic, Istanbul, Turkey https://orcid.org/0000-0003-3995-3557
  • Yucel Cihan, MD Prof. Dr. Cemil Tascıoglu City Hospital, Cardiovascular Surgery Clinic, Istanbul, Turkey https://orcid.org/0000-0002-1941-0873
  • Gultekin Yildirim, MD Department of Cardiovascular Surgery, Kirikkale University Medical School, Kirikkale, Turkey

DOI:

https://doi.org/10.1532/hsf.4621

Keywords:

Type 2 diabetes mellitus, insulin, oral antidiabetic, coronary artery bypass

Abstract

Background: Acute kidney injury (AKI) is one of the most important complications after cardiac surgery and is one of the main causes of morbidity and mortality. Diabetes mellitus also is one of the main risk factors for renal dysfunction in coronary artery bypass graft (CABG). In this study, we aimed to compare the early postoperative period results of type 2 diabetes patients taking oral antidiabetics (OAD) or insulin medications, with microalbuminuria and normal creatinine levels after CABG.

Methods: Eighty patients with type 2 diabetes and taking OAD or receiving insulin medication all with normal creatinine levels with microalbuminuria were included in this study. Preoperative creatinine values of the patients, albumin levels in spot urine, creatinine levels on the postoperative 3rd day, duration of ventilation, amount of drainage, length of stay in the intensive care unit, length of stay in the hospital, mediastinitis, and mortality rates were recorded.

Results: A statistically significant increase in creatinine was found in both taking OAD type 2 diabetes and insulin medication with microalbuminuria. When the two groups were compared with each other, the increase in creatinine levels of the patients using insulin was higher than the patients taking OAD. It also was statistically significant.

Conclusion: According to the result of our study, it can be suggested that postoperative creatinine elevation is observed in patients with type 2 diabetes mellitus with microalbuminuria and with normal creatinine levels, either having insulin medication or not. The elevation is higher in patients having insulin medication, while other results are similar, except for impaired renal function.

References

Almassi GH, Sommers T, Moritz TE, et al. 1999. Stroke in cardiac surgical patients: determinants and outcome. Ann Thorac Surg. 68(2):391-7.

Amann K, Wanner C, Ritz E. 2006. Cross-talk between the kidney and the cardiovascular system. J Am Soc Nephrol. 17:2112-19.

Asimakopoulos G, Smith PL, Ratnatunga CP, et al. 1999. Lung injury and acute respiratory distress syndrome after cardiopulmonary bypass. Ann Thorac Surg. 68(3):1107-15.

Carson J, Scholz PM, Chen A, 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.

Cohen Y, Raz I, Merin G, et al. 1998. Comparison of factors associated with 30 -day mortality after coronary artery bypass grafting in patients with versus without diabetes mellitus. Am J Cardiol. 81:7-11.

Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, et al. 1989. Albuminuria reflects widespread vascular damage. The Steno hypothesis. Diabetologia. 32:219-26.

Eagle KA, Guyton RA, Davidoff R, et al. 1999. ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery). American College of Cardiology/American Heart Association. J Am Coll Cardiol. 34(4):1262-347.

Francel TJ, Kouchoukos NT. 2001. A rational approach to wound difficulties after sternotomy: the problem. Ann Thorac Surg. 72:1411-8.

Gerstein HC, Mann JF, Yi Q, et al. 2001. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA. 286:421-6.

Gulack BC, Kirkwood KA, Shi W, et al. 2018. Secondary surgical-site infection after coronary artery bypass grafting: A multi-institutional prospective cohort study. J Thorac Cardiovasc Surg. 155(4):1555-62.

Gültekin Y, Bolat A. 2020. Bir üniversite hastanesi kliniğinde yapılan ilk 200 açık kalp ameliyatı sonuçları: Kırıkkale Üniversitesi, Tıp Fakültesi, Kalp-Damar Cerrahisi, KÜ Tıp Fak Derg. 22(3):348-56.

Gultekin Y, Bolat A, Hatice K, et al. 2021. Does Aspartate Aminotransferase to Alanine Aminotransferase Ratio Predict Acute Kidney Injury After Cardiac Surgery? Heart Surg Forum. 24(3):506-11.

Jarraya F, Lakhdar R, Kammoun K, et al. 2013. Microalbuminuria A Useful Marker of Cardiovascular Disease. Iranıan J Kidney Dis. 7(3):178-86.

Jensen T, Borch-Johnsen K, Kofoed-Enevoldsen A, et al. 1987. Coronary heart disease in young type I (insulin-dependent) diabetic patients with and without diabetic nephropathy: incidence and risk factors. Diabetologia. 30:144-8.

Kunt AT, Akgün S, Atalan S, et al. 2009. Furosemide infusion prevents the requirement of renal replacement therapy after cardiac surgery. Anadolu Kardiyol Derg. 9:499-504.

Levy JH, Tanaka KA. 2003. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg. 75(2): 715-20.

Mangano CM, Diamondstone LS, Ramsay JG, et al. 1998. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med. 128(3):194-203.

Mazzarella V, Gallucci MT, Tozzo C, et al. 1992. Renal function in patients undergoing cardiopulmonary bypass operations. J Thorac Cardiovasc Surg. 104(6):1625–7.

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

Mishra J, Dent C, Tarabishi R, et al. 2005 Neutrophil gelatinase-associated lipocalin (NGAL) as biomarker for acute renal injury following cardiac surgery. Lancet. 365:1231-8.

Mogensen CE. 1984. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med. 6:356-60.

Patrick AW, Leslie PJ, Clarke BF, et al. 1990. Natural history and associations of microalbuminuria in type 2 diabetes during the first year after diagnosis, Diabet Med. 7: 902-8.

Perkins BA, Ficociello LH, Ostrander BE, et al. 2007. Microalbuminuria and the risk for early progressive renal function decline in type 1 diabetes. J Am Soc Nephrol. 18:1353-61.

Remuzzi G, Bertani T. 1990. Is glomerulosclerosis a consequence of altered glomerular permeability to macromolecules? Kidney Int. 38:384-94.

Shafranskaya KS, Kashtalap VV, Kutikhin AG, et al. 2015. Microalbuminuria and prediction of cardiovascular complications in patients with coronary artery disease and type 2 diabetes mellitus after CABG surgery. Heart Lung Circ. 24(10):951-9.

Thourani VH, Weintraub WS, Stein B, et al. 1999. Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting. Ann Thorac Surg. 67:1045-52.

Turner R, Millins H, Neil H, et al. 1998. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS: 23) the United Kingdom Prospective Diabetes Study Group. BMJ. 316: 823-28.

Vazquez-Benitez G, Desai JR, Xu S, et al. 2015. Preventable major cardiovascular events associated with uncontrolled glucose, blood pressure, and lipids and active smoking in adults with diabetes with and without cardiovascular disease: a contemporary analysis. Diabetes Care. 38(5): 905-12.

Viberti GC, Hill RD, Jarrett RJ, et al. 1982. Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet. 1(8287):1430-2.

Yavuz S, Ayabakan N, Goncu MT, et al. 2002. Effect of combined dopamine and diltiazem on renal function after cardiac surgery. Med Sci Monit. 8(5):145-50.

Yudkin JS, Forrest RD, Jackson CA, 1988. Microalbuminuria as predictor of vascular disease in non-diabetic subjects. Islington Diabetes Survey. Lancet 2(8610):530–3.

Zarich SW, Arbuckle BE, Cohen LR, et al. 1988. Diastolic abnormalities in young asymptomatic diabetic patients assessed by pulsed Doppler echocardiography. J Am Coll Cardiol. 12:114-20.

Published

2022-05-31

How to Cite

Gemalmaz, . H., Unal, C., & Gültekin, Y. (2022). Evaluation of Early Postoperative Period Results of Patients With Type 2 Diabetes Taking Oral Anti-Diabetics Or Insulin Medications, With Microalbuminuria and Normal Creatinine Levels After Coronary Artery Bypass. The Heart Surgery Forum, 25(3), E407-E412. https://doi.org/10.1532/hsf.4621

Issue

Vol. 25 No. 3 (2022)

Section

Articles

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