Acute kidney injury and its prognostic value for patients with metabolic syndrome and intact glomerular filtration who underwent coronary artery bypass grafting
B.G. Iskenderov, O.N. Sisina
SBEI FPE "Penza Institute of Advanced Training" of RMPH
Purpose. To determine the incidence of acute kidney injury (AKI) and its prognostic value for patients with metabolic syndrome (MS) and intact glomerular filtration undergoing coronary artery bypass grafting (CABG).
Material and methods. A total of 782 patients (514 men and 268 women) aged 54 to 67 years (mean age – 62.3 ± 4.6 years), who routinely underwent CABG with extracorporeal circulation, were evaluated. Of these, 513 (65.6%) patients had no diagnostic criteria for MS (Group 1), while 269 (34.4%) patients were diagnosed with MS (Group 2). For all patients, the initial value of the glomerular filtration rate (GFR) was greater than 60 mL/min/1.73 m2, as defined by EPI-CKD creatinine equation.
Results. In Group 1, postoperative AKI occurred in 123 (24.0%) patients, in the Group 2 - in 94 patients (34.9%). As a result, both groups were divided in two subgroups - those with and without AKI. In Group 1, stage I AKI and transient AKI were significantly more frequently detected, and in the Group 2 - stage III AKI and persistent AKI. In both groups, the development of AKI was associated with a high rate of early cardiovascular events after CABG, and intergroup difference were revealed, especially in patients who did not have AKI. It is shown that the majority of parameters of MS were significantly higher in the Group 2 than in the Group 1 regardless the presence of the AKI. In-hospital mortality in both groups of patients with AKI was significantly higher than in patients without the AKI.
Conclusion. It is revealed that the presence of MS in patients undergoing coronary artery bypass grafting is associated with a high incidence of AKI and poor prognosis in immediate postoperative period.
- Национальные рекомендации по диагностике и лечению метаболического синдрома. Всероссийское научное общество кардиологов. Второй пересмотр // Кардиоваскулярная терапия и профилактика. – 2009. – Т. 8(6). – Приложение 2.
- Kajimoto K., Miyauchi K., Kasai T. et al. Metabolic syndrome is an independent risk factor for stroke and acute renal failure after coronary artery bypass grafting // J Thorac Cardiovasc Surg. – 2009. – Vol. 137(3). – P. 658–663.
- van Straten A.H.M., Bramer S., Soliman Hamad M.A. et al. Effect of body mass index on early and late mortality after coronary artery bypass grafting // Ann Thorac Surg. – 2010. – Vol. 89(1). – P. 30–37.
- Park S.H., Shin W.Y., Lee E.Y. et al. The impact of hyperuricemia on in-hospital mortality and incidence of acute kidney injury in patients undergoing percutaneous coronary intervention // Circulation. – 2011. – Vol. 75(3). – P. 692–697.
- Wijns W., Kolh P., Danchin N. et al. Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery (EACTS) // Eur Heart J. – 2010. – Vol. 31(20). – P. 2501–2555.
- Hobson C.E., Yavas S., Segal M.S. et al. Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery // Circulation. – 2009. – Vol. 119. – P. 2444–2453.
- Orii K., Hioki M., Iedokoro Y. et al. Prognostic factors affecting clinical outcomes after coronary artery bypass surgery: analysis of patients with chronic kidney disease after 5.9 years of follow-up // J Nippon Med Sch. – 2011. – Vol. 78(3). – P. 156–165.
- Angeloni E., Melina G., Benedetto U. et al. Metabolic syndrome affects midterm outcome after coronary artery bypass grafting // Ann Thorac Surg. – 2012. – Vol. 93(2). – P. 537–544.
- Rahmanian P.B., Adams D.H., Castillo J.G. et al. Impact of body mass index on early outcome and late survival in patients undergoing coronary artery bypass grafting or valve surgery or both // Am J Cardiol. – 2007. – Vol. 100(11). – P. 1702–1708.
- Ejaz A.A., Dass B., Lingegowda V. et al. Effect of uric acid lowering therapy on the prevention of acute kidney injury in cardiovascular surgery // Int Urology and Nephrology. – 2013. – Vol. 45(2). – P. 449–458.
- Engel A.M., McDonough S., Smith J.M. Does an obese body mass index affect hospital outcomes after coronary artery bypass graft surgery? // Ann Thorac Surg. – 2009. – Vol. 88(6). – P. 1793–1800.
- Charytan D.M., Yang S.S., McGurk S. et al. Long and short-term outcomes following coronary artery bypass grafting in patients with and without chronic kidney disease // Nephrol Dial Transplant. – 2010. – Vol. 25. – P. 3654–3663.
- Искендеров Б.Г., Сисина О.Н. Факторы риска и исходы острого повреждения почек у пациентов с сохранной функцией почек, подвергнутых аортокоронарному шунтированию // Нефрология. – 2013. – № 3. – С. 63–67.
- Смирнов А.В., Каюков И.Г., Дегтярева О.А. и др. Проблемы диагностики и стратификации тяжести острого повреждения почек // Нефрология. – 2009. – № 3. – С. 9–18.
About the Autors
Information about the authors:
Iskenderov B.G. - Professor at the Department of Therapy, Cardiology and Functional Diagnostics SBEI FPE "Penza Institute of Advanced Training" of RMPH, MD
Sisina O.N. - Head of the Department of Nephrology SBEI FPE "Penza Institute of Advanced Training" of RMPH, Associate Professor, PhD in Medical Sciences.