title: Hyperglycemia and Acute Kidney Injury During the Perioperative Period.
abstract: Hyperglycemia and acute kidney injury (AKI) are frequently observed during the perioperative period. Substantial evidence indicates that hyperglycemia increases the prevalence of AKI as a surgical complication. Patients who develop hyperglycemia and AKI during the perioperative period are at significantly elevated risk for poor outcomes such as major adverse cardiac events and all-cause mortality. Early observational and interventional trials demonstrated that the use of intensive insulin therapy to achieve strict glycemic control resulted in remarkable reductions of AKI in surgical populations. However, more recent interventional trials and meta-analyses have produced contradictory evidence questioning the renal benefits of strict glycemic control. Although the exact mechanisms through which hyperglycemia increases the risk of AKI have not been elucidated, multiple pathophysiologic pathways have been proposed. Hypoglycemia and glycemic variability may also play a significant role in the development of AKI. In this literature review, the complex relationship between hyperglycemia and AKI as well as its impact on clinical outcomes during the perioperative period is explored.
authors.affiliation: Albany Stratton VA Medical Center, Albany Medical College, 113 Holland Avenue, Albany, NY, 12208, USA. carlos.mendez2@va.gov.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Mendez
authors.affiliation: Albany Stratton VA Medical Center, Albany Medical College, 113 Holland Avenue, Albany, NY, 12208, USA. Paul.DerMesropian2@va.gov.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Der Mesropian
authors.affiliation: Albany Stratton VA Medical Center, Albany Medical College, 113 Holland Avenue, Albany, NY, 12208, USA. Roy.Mathew@va.gov.
authors.forename: Roy O
authors.initials: RO
authors.lastname: Mathew
authors.affiliation: Department of Medicine, Froedtert and Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA. bslawski@mcw.edu.
authors.forename: Barbara
authors.initials: B
authors.lastname: Slawski
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy; D000818:Animals; D001786:Blood Glucose / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D007328:Insulin / Q000627:therapeutic use; D059035:Perioperative Period; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: Acute kidney injury; Glycemic variability; Hyperglycemia; Hypoglycemia; Inpatient glycemic control; Perioperative; Postoperative