title: Chronic hyperglycemia is associated with acute kidney injury in patients undergoing CABG surgery--a cohort study.
abstract: BACKGROUND
  Chronic hyperglycemia (CHG) with HbA1c as an indicator affects postoperative mortality and morbidity after coronary artery bypass grafting surgery (CABG). Acute kidney injury (AKI) is one of the frequent postoperative complications after CABG impacting short-and long-term outcomes. We investigated the association between CHG and postoperative incidence of AKI in CABG patients with and without history of diabetes mellitus (DM).
  
  
  METHODS
  This cohort study consecutively enrolled patients undergoing CABG in 2009 at the department for cardiovascular surgery. CHG was defined as HbA1c ≥ 6.0%. Patients with advanced chronic kidney disease (CKD) were excluded. The incidence of postoperative AKI and its association with CHG was analyzed by univariate and multivariate logistic regression modeling.
  
  
  RESULTS
  Three-hundred-seven patients were analyzed. The incidence of AKI was 48.2%. Patients with CHG (n = 165) were more likely to be female and had greater waist circumference as well as other comorbid conditions, such as smoking, history of DM, CKD, hypertension, pulmonary hypertension, and chronic obstructive pulmonary disease (all p ≤ 0.05). Preoperative eGFR, atrial fibrillation (AF), history of DM and CHG were associated with an increased risk of postoperative AKI in univariate analyses. In multivariate modelling, history of DM as well as preoperative eGFR and AF lost significance, while age, CHG and prolonged OP duration (p < 0.05) were independently associated with postoperative AKI.
  
  
  CONCLUSIONS
  Our results suggest that CHG defined on a single measurement of HbA1c ≥ 6.0% was associated with the incidence of AKI after CABG. This finding might implicate that treatment decisions, including the selection of operative strategies, could be based on HbA1c measurement rather than on a recorded history of diabetes.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany. Oezkur_m@ukw.de.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Oezkur
authors.affiliation: Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany. wagner_m@ukw.de.|Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany. wagner_m@ukw.de.|Department of Internal Medicine I, Division of Nephrology, University Hospital Würzburg, Würzburg, Germany. wagner_m@ukw.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Wagner
authors.affiliation: Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany. weismann_d@ukw.de.|Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany. weismann_d@ukw.de.
authors.forename: Dirk
authors.initials: D
authors.lastname: Weismann
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany. krannich_j@ukw.de.
authors.forename: Jens Holger
authors.initials: JH
authors.lastname: Krannich
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany. Schimmer_c@ukw.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schimmer
authors.affiliation: Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany. Riegler_C@ukw.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Riegler
authors.affiliation: Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany. E_Ruecker_V@ukw.de.
authors.forename: Victoria
authors.initials: V
authors.lastname: Rücker
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany. Leyh_r@ukw.de.
authors.forename: Rainer
authors.initials: R
authors.lastname: Leyh
authors.affiliation: Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany. E_Heuschma_P@ukw.de.|Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany. E_Heuschma_P@ukw.de.|Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany. E_Heuschma_P@ukw.de.
authors.forename: Peter U
authors.initials: PU
authors.lastname: Heuschmann
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000367:Age Factors; D000368:Aged; D002908:Chronic Disease; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D048909:Diabetes Complications / Q000097:blood; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D003404:Creatinine; D006442:Glycated Hemoglobin