Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Pharmacotherapy. 2023 Aug;43(8):778-786. doi: 10.1002/phar.2827. Epub 2023 Jun 1.
Acute kidney injury (AKI) is a common and serious complication after coronary artery bypass grafting (CABG) surgery. Patients with diabetes are commonly associated with renal microvascular complications and have a greater risk of AKI after CABG surgery. This study aimed to explore whether preoperative metformin administration could reduce the incidence of postoperative AKI following CABG in patients with type 2 diabetes.
Patients with diabetes who underwent CABG were retrospectively included in this study. AKI after CABG was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The effects of metformin on postoperative AKI following CABG in patients were compared and analyzed.
Patients were enrolled in this study between January 2019 and December 2020 in Beijing Anzhen Hospital.
A total of 812 patients were enrolled. The patients were divided into the metformin group (203 cases) and the control group (609 cases) according to whether metformin was used preoperatively.
Inverse probability of treatment weighting (IPTW) was applied to minimize baseline differences between the two groups. IPT-weighted p values were analyzed to evaluate the postoperative outcomes between the two groups.
The incidence of AKI in the metformin group and the control group was compared. After IPTW adjustment, the incidence of AKI in the metformin group was lower than the control group (IPTW-adjusted p < 0.001). In the subgroup analysis, metformin showed significant protective effects in the estimated glomerular filtration rate (eGFR) < 60 mL/min per 1.73 m and eGFR 60-90 mL/min per 1.73 m subgroups, which was not observed in the eGFR ≥90 mL/min per 1.73 m subgroup. No significant differences in the incidence of renal replacement therapy, reoperation due to bleeding, in-hospital mortality, or red blood cell transfusion volume were observed between the two groups.
In this study, we provided evidence that preoperative metformin was associated with a significant reduction of postoperative AKI following CABG in patients with diabetes. Metformin showed significant protective effects in patients with mild-to-moderate renal insufficiency.
急性肾损伤（AKI）是冠状动脉旁路移植术（CABG）后的常见且严重的并发症。患有糖尿病的患者通常与肾脏微血管并发症相关，并且在 CABG 手术后发生 AKI 的风险更高。本研究旨在探讨术前给予二甲双胍是否可以降低 2 型糖尿病患者 CABG 术后 AKI 的发生率。
本研究回顾性纳入接受 CABG 的糖尿病患者。根据肾脏疾病改善全球结局（KDIGO）标准定义 CABG 后的 AKI。比较并分析二甲双胍对 CABG 术后 AKI 的影响。
患者于 2019 年 1 月至 2020 年 12 月在北京安贞医院入组。
共纳入 812 例患者。根据术前是否使用二甲双胍，患者分为二甲双胍组（203 例）和对照组（609 例）。
应用逆概率治疗加权（IPTW）以尽量减少两组间的基线差异。分析 IPT 加权 p 值以评估两组间术后结局。
比较了二甲双胍组和对照组的 AKI 发生率。经过 IPTW 调整后，二甲双胍组的 AKI 发生率低于对照组（调整后 IPT 加权 p<0.001）。在亚组分析中，在估计肾小球滤过率（eGFR）<60mL/min/1.73m 和 eGFR 60-90mL/min/1.73m 亚组中，二甲双胍显示出显著的保护作用，但在 eGFR≥90mL/min/1.73m 亚组中未观察到这种作用。两组间肾脏替代治疗、因出血再次手术、住院死亡率或红细胞输注量的发生率无显著差异。
本研究提供了证据表明，术前给予二甲双胍可显著降低糖尿病患者 CABG 术后 AKI 的发生率。二甲双胍在轻中度肾功能不全患者中具有显著的保护作用。
