Tight perioperative glucose control is associated with a reduction in renal impairment and renal failure in non-diabetic cardiac surgical patients.
Crit Care. 2008 Dec 4;12(6):R154
Authors: Lecomte P, Van Vlem B, Coddens J, Cammu G, Nollet G, Nobels F, Vanermen H, Foubert L
ABSTRACT: INTRODUCTION: Acute renal failure after cardiac surgery increases in-hospital mortality. We evaluated the effect of intra- and postoperative tight control of blood glucose levels on renal function after cardiac surgery based on the Risk, Injury, Failure, Loss, and End-stage kidney failure (RIFLE) criteria, and on the need for acute postoperative dialysis. METHODS: We retrospectively analysed two groups of consecutive patients undergoing cardiac surgery with cardiopulmonary bypass between August 2004 and June 2006. In the first group, no tight glycaemic control was implemented (Control, n=305). Insulin therapy was initiated at blood glucose levels > 150 mg/dL. In the group with tight glycaemic control (insulin, n=745), intra- and postoperative blood glucose levels were targeted between 80-110 mg/dL, using the Aalst Glycaemia Insulin Protocol. Postoperative renal impairment or failure was evaluated with the RIFLE score, based on serum creatinine, glomerular filtration rate and/or urinary output. We used the Cleveland Clinic Severity Score to compare the predicted versus observed incidence of acute postoperative dialysis between groups. RESULTS: Mean blood glucose levels in the Insulin group were lower compared to the Control group from rewarming on cardiopulmonary bypass onwards until ICU discharge (P<0.0001). Median ICU stay was 2 days in both groups. In non-diabetics, strict perioperative blood glucose control was associated with a reduced incidence of renal impairment (P=0.01) and failure (P=0.02) scoring according to RIFLE criteria, as well as a reduced incidence of acute postoperative dialysis (from 3.9% in Control to 0.7% in Insulin; P<0.01). Thirty-day mortality was lower in the Insulin than in the Control group (1.2 vs. 3.6%; P=0.02), representing a 70% decrease in non-diabetics (P<0.05) and 56.1% in diabetics (NS). The observed overall incidence of acute postoperative dialysis was adequately predicted by the Cleveland Clinic Severity Score in the Control group (P=0.6), but was lower than predicted in the Insulin group (1.2 vs. 3%, P=0.03). CONCLUSIONS: In non-diabetic patients, tight perioperative blood glucose control is associated with a significant reduction in postoperative renal impairment and failure after cardiac surgery according to the RIFLE criteria. In non-diabetics, tight blood glucose control was associated with a decreased need for postoperative dialysis, as well as 30-day mortality, despite of a relatively short ICU stay.
PMID: 19055829 [PubMed - as supplied by publisher]