The relationship between renal oxygen saturation and renal function in patients with and without diabetes following coronary artery bypass grafting surgery

Öz

Background/Aim: Acute kidney injury may occur due to renal ischemia and hypoxia during coronary artery bypass surgery. Monitoring of renal regional tissue oxygenation might be useful to determine renal hypoxia. We aimed to investigate whether renal oxygen saturation values differ between diabetic and non-diabetic patients and evaluate the relationship between intra-operative renal oxygen saturation values and postoperative renal function. Methods: Forty consecutive patients aged 18-65 years, who underwent elective coronary artery bypass grafting, were included in this prospective case-control study. Body mass index ≥30 kg/m2 and the presence of renal damage were considered the exclusion criteria. Group I consisted of diabetic patients (n = 20), and Group II consisted of non-diabetic patients (n = 20). Near Infrared Spectroscopy (NIRS) recorded renal saturation values just before the intubation as the basal value and every 10 minutes after intubation in all patients. Creatinine clearances and glomerular filtration rates were calculated along with blood urea nitrogen and creatinine values on the postoperative 1st and 3rd days of all patients. Results: The two groups were similar in terms of gender, age, body mass index, duration of surgery, cross-clamp time, and total cardiopulmonary bypass duration (P>0.05). While there was no difference between baseline values, significant differences were found between preoperative BUN and creatinine and POD 3 BUN and creatinine values in Group 1 (P=0.003 and P=0.046, respectively) and Group 2 (P=0.018 and P=0.030, respectively). There was no significant difference between two groups in renal oxygen saturation values considering both basal and post-intubation measurements (P>0.05 for all). However, an earlier decrease in renal oxygen saturation values was seen in diabetic patients (P<0.05). There was no significant relationship between the changes in intraoperative renal oxygen saturation values and postoperative renal function (P>0.05 for all). Conclusion: Although coronary artery graft bypass surgery does not lead to a significant difference in renal saturation values, as determined by Near Infrared Spectroscopy, in diabetic patients compared to non-diabetic patients, NIRS may be helpful and beneficial to show renal ischemia in these patients.

Anahtar Kelimeler

• Diabetes mellitus
• Coronary artery bypass grafting
• Near-infrared spectroscopy
• Acute kidney injury

Kaynakça

1. 1. Choi DK, Kim WJ, Chin JH, Lee EH, Don Hahm K, Yeon Sim J, Cheol Choi I. Intraoperative Renal Regional Oxygen Desaturation Can Be a Predictor for Acute Kidney Injury after Cardiac Surgery. J Cardiothorac Vasc Anesth. 2014;28:564-71.
2. 2. Li S, Krawczeski CD, Zappitelli M, Devarajan P, Thiessen-Philbrook H, Coca SG, et al. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med. 2011;39:1493–9.
3. 3. Pedersen K. Acute kidney injury in children undergoing surgery for congenital heart disease. Eur J Pediatr Surg. 2012;22:426–33.
4. 4. Aydin SI, Seiden HS, Blaufox AD, Parnell VA, Choudhury T, Punnoose A, et al. Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg. 2012;94:1589–95.
5. 5. Owens GE, King K, Gurney JG, Charpie J R. Low Renal Oximeter Correlates With Acute Kıdney Injury After Infant Cardiac Surgery. Pediatr Cardiol. 2011;32:183-8.
6. 6. Hazle MA, Gajarski RJ, Aiyagari R, Yu S, Abraham A, Donohue J, et al. Urinary biomarkers and renal near-infrared spectroscopy predict intensive care unit outcomes after cardiac surgery in infants younger than 6 months of age. J Thorac Cardiovasc Surg. 2013;146:861–7.
7. 7. Cao Z, Cooper ME. Pathogenesis of diabetic nephropathy. J Diabetes Investig. 2011;2:243-7.
8. 8. Pöge U, Gerhardt T, Stoffel-Wagner B, Klehr HU, Sauerbruch T, Woitas RP. Calculation of glomerular filtration rate based on cystatin C in cirrhotic patients. Nephrol Dial Transplant. 2006;21:660-4.

9. 9. Ascione R, Talpahewa S, Rajakaruna C, Reeves BC, Lovell AT, Cohen A, Angelini GD. Splanchnic organ injury during coronary surgery with or without cardiopulmonary bypass a randomized controlled trial. Ann Thorac Surg. 2006;81:97-103.
10. 10. Khilji SA, Khan AH. Acute renal failure after cardiopulmonary bypass surgery. J Ayub Med Coll Abbottabad. 2004;16:25-8.
11. 11. Raza JA, Movahed A. Current concepts of cardiovascular diseases in diabetes mellitus. Int J Cardiol. 2003;89:123-34.
12. 12. Carson JL, Scholz PM, Chen AY, Peterson ED, Gold J, Schneider SH. Diabetes mellitus increases shorter mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am Coll Cardiol. 2002;40:418-23.
13. 13. McDonnell ME, Alexanian SM, White L, Lazar HL. A primer for achieving glycemic control in the cardiac surgical patient. J Card Surg. 2012;27:470-7.
14. 14. Saran R, Robinson B, Abbott KC, Agodoa LYC, Bhave N, Bragg-Gresham J, et al. US Renal Data System 2017 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2018;71:7.
15. 15. Stallwood MI, Grayson AD, Mills K, Scawn ND. Acute renal failure in coronary artery bypass surgery: independent effect of cardiopulmonary bypass. Ann Thorac Surg. 2004;77:968-72.
16. 16. Bahar I, Akgul A, Ozatik MA, Vural KM, Demirbag AE, Boran M, et al. Acute renal failure following open heart surgery: risk factors and prognosis. Perfusion. 2005 Oct;20:317-22.
17. 17. Thakar CV, Liangos O, Yared JP, Nelson D, Piedmonte MR, Hariachar S, et al. ARF after open-heart surgery: Influence of gender and race. Am J Kidney Dis. 2003;41:742-51.
18. 18. Cooper WA, O'Brien SM, Thourani VH, Guyton RA, Bridges CR, Szczech LA, et al. Impact of renal dysfunction on outcomes of coronary artery bypass surgery: results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation. 2006;113:1063-70.
19. 19. Karkouti K, Beattie WS, Wijeysundera DN, Rao V, Chan C, Dattilo KM, et al. Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery. J Thorac Cardiovasc Surg. 2005;129:391-400.
20. 20. Oprea AD, Del Rio JM, Cooter M, Green CL, Karhausen JA, Nailer P, et al. Pre- and postoperative anemia, acute kidney injury, and mortality after coronary artery bypass grafting surgery: a retrospective observational study. Can J Anaesth. 2018;65:46-59.
21. 21. Kumar AB, Suneja M. Cardiopulmonary bypass-associated acute kidney injury. Anesthesiology. 2011;114:964-70.