Correction of dilutional anemia induces renal dysfunction in diabetic patients undergoing coronary artery bypass grafting: a consequence of microcirculatory alterations?
In this study we aimed to evaluate the effects of dilutional anemia resulting from cardiopulmonary bypass (CPB) and its correction with red blood cell (RBC) transfusion on tissue oxygenation and renal function in diabetic patients undergoing coronary artery bypass grafting (CABG).



70 diabetic patients who underwent elective CABG and whose hematocrit values had been between 24-28% at any time during CBP were prospectively randomized and equally allocated to two groups: patients who received RBC during CPB (group I, n = 35) vs. did not receive RBC during CPB (group II, n = 35). Besides routine hemodynamic and biochemical parameters, biomarkers of ischemia and renal injury such as ischemia modified albumin (IMA), protein oxidation parameters [advanced oxidative protein products (AOPP), total thiol (T-SH)], neutrophil gelatinase-associated lipocalin (NGAL) and estimated glomerular filtration rate (eGFR) were measured in both groups.



In group I, T-SH, NGAL and urea levels were found to be significantly increased postoperatively compared to preoperative measurements (p < 0.05). Also, postoperatively, NGAL, creatinine, aspartate aminotransferase and AOPP levels were higher in group I than group II (p < 0.05).



The correction of anemia with RBC transfusion in diabetic patients undergoing CABG could increase the risk of renal injury. Further studies verifying the effects of blood transfusions at the microcirculatory level are needed to optimize the efficacy of transfusions.
Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
Güçlü
G
Aykut
Department of Biochemistry, School of Medicine, Acıbadem University, Istanbul, Turkey.
Meltem
M
Kilercik
Department of Cardiovascular Surgery, School of Medicine, Acıbadem University, Istanbul, Turkey.
Cem
C
Arıtürk
Department of Anesthesiology and Reanimation, School of Medicine, Acibadem Kadiköy Hospital, Acıbadem University, Tekin sok. No: 8, 34713 Kadiköy, Istanbul, Turkey.
Halim
H
Ulugöl
Department of Biology, Faculty of Science, Istanbul University, Istanbul, Turkey.
Uğur
U
Aksu
Department of Anesthesiology and Reanimation, Dr Siyami Ersek Thoracic and Cardiovascular Training and Research Hospital, Istanbul, Turkey.
Türkan
T
Kudsioğlu
Department of Anesthesiology and Reanimation, Dr Siyami Ersek Thoracic and Cardiovascular Training and Research Hospital, Istanbul, Turkey.
Nazan
N
Atalan
Department of Anesthesiology and Reanimation, Dr Siyami Ersek Thoracic and Cardiovascular Training and Research Hospital, Istanbul, Turkey.
Nihan
N
Yapıcı
Department of Cardiovascular Surgery, School of Medicine, Acıbadem University, Istanbul, Turkey.
Hasan
H
Karabulut
Department of Anesthesiology and Reanimation, School of Medicine, Acibadem Kadiköy Hospital, Acıbadem University, Tekin sok. No: 8, 34713 Kadiköy, Istanbul, Turkey. ftoraman@gmail.com.
Fevzi
F
Toraman
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000652:urine*; D062107:Advanced Oxidation Protein Products / Q000097:blood; D000740:Anemia / Q000209:etiology / Q000628:therapy*; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood / Q000652:urine; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D048909:Diabetes Complications / Q000150:complications / Q000503:physiopathology*; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007511:Ischemia / Q000097:blood / Q000209:etiology; D000071068:Lipocalin-2 / Q000652:urine; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000075462:Serum Albumin, Human; D013438:Sulfhydryl Compounds / Q000097:blood
D062107:Advanced Oxidation Protein Products; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D013438:Sulfhydryl Compounds; C561522:ischemia-modified albumin; D003404:Creatinine; D001219:Aspartate Aminotransferases; D000075462:Serum Albumin, Human
Acute kidney dysfunction; Cardiac surgery; Diabetes; Microcirculation; Transfusion