Moschopoulou Maria, Ampatzidou Foteini Ch, Loutradis Charalampos, Boutou Afroditi, Koutsogiannidis Charilaos-Panagiotis, Drosos Georgios E, Sarafidis Pantelis A
Department of Cardiothoracic Surgery, Papanikolaou Hospital, Thessaloniki, Greece.
Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, GR54642, Thessaloniki, Greece.
J Nephrol. 2016 Dec;29(6):835-845. doi: 10.1007/s40620-016-0281-x. Epub 2016 Feb 29.
Acute kidney injury (AKI) after cardiac surgery is a common complication associated with increased mortality. However, the heterogeneity of the definitions used results in high variance of incidence rates in the literature. Data on the effect of diabetes mellitus on AKI incidence in this setting are scarce. We thus aimed to compare the incidence of AKI (defined by the AKIN, RIFLE and KDIGO criteria) in diabetic vs. non-diabetic patients undergoing cardiac surgery.
This is a nested case-control study from a cohort of patients undergoing cardiac surgery between 1/1/2013 and 30/6/2014 in a single center. Exclusion criteria were: type-1 diabetes, end-stage renal disease, death during surgery and AKI prior to surgery. We identified 199 type-2 diabetic patients and matched them for gender, age and estimated glomerular filtration rate (eGFR) to 199 non-diabetic individuals. The incidence of AKI between the two groups was compared in the total population and in subgroups according to preoperative eGFR. Univariate and multivariate logistic regression analysis were conducted to identify factors associated with AKI.
The incidence of AKI was moderately high, but similar between the two study groups (AKIN and KDIGO: 24.1 vs. 23.1 %; p = 0.906, RIFLE: 25.1 vs. 25,1 %; p = 1.000, in diabetics and non-diabetics respectively). A trend towards increased incidence of AKI from eGFR subgroup 1 to subgroup 3a was noted in diabetic patients (p = 0.04). No significant differences were detected between the two study groups within any eGFR subgroup studied. At multivariate analysis, age [per year increase: odds ratio (OR) 1.034, 95 % confidence interval (CI) 1.001-1.068] and duration of cardiopulmonary bypass [per minute increase: OR 1.009 (1.003-1.015)] were associated with AKI. Diabetes was not related to AKI development in regression analysis [OR 1.057 (0.666-1.679)].
Incidence of AKI after cardiac surgery is high, but diabetes is not a risk factor for AKI. Baseline renal function in diabetics is related inversely to the incidence of AKI. Age and cardiopulmonary bypass duration are independent predictors of cardiac surgery-associated AKI.
心脏手术后急性肾损伤（AKI）是一种常见并发症，与死亡率增加相关。然而，所使用定义的异质性导致文献中发病率差异很大。关于糖尿病对这种情况下AKI发病率影响的数据很少。因此，我们旨在比较接受心脏手术的糖尿病患者与非糖尿病患者中AKI的发病率（根据AKIN、RIFLE和KDIGO标准定义）。
这是一项嵌套病例对照研究，来自于2013年1月1日至2014年6月30日在单一中心接受心脏手术的患者队列。排除标准为：1型糖尿病、终末期肾病、手术期间死亡和术前AKI。我们确定了199例2型糖尿病患者，并根据性别、年龄和估计肾小球滤过率（eGFR）将他们与199例非糖尿病个体进行匹配。比较两组在总体人群和根据术前eGFR划分的亚组中的AKI发病率。进行单因素和多因素逻辑回归分析以确定与AKI相关的因素。
AKI的发病率中等偏高，但两个研究组之间相似（AKIN和KDIGO标准：糖尿病患者和非糖尿病患者分别为24.1%对23.1%；p = 0.906，RIFLE标准：25.1%对25.1%；p = 1.000）。在糖尿病患者中，注意到从eGFR亚组1到亚组3a的AKI发病率有增加趋势（p = 0.04）。在任何研究的eGFR亚组内，两个研究组之间未检测到显著差异。在多因素分析中，年龄[每年增加：比值比（OR）1.034，95%置信区间（CI）1.001 - 1.068]和体外循环持续时间[每分钟增加：OR 1.009（1.003 - 1.015）]与AKI相关。在回归分析中，糖尿病与AKI的发生无关[OR 1.057（0.666 - 1.679）]。
心脏手术后AKI的发病率很高，但糖尿病不是AKI的危险因素。糖尿病患者的基线肾功能与AKI的发病率呈负相关。年龄和体外循环持续时间是心脏手术相关AKI的独立预测因素。
