Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2018 Nov;40(1):611-617.
doi: 10.1080/0886022X.2018.1532908.

Wider intraoperative glycemic fluctuation increases risk of acute kidney injury after pediatric cardiac surgery

Guo-Huang Hu  1 , Lian Duan  2 , Meng Jiang  2 , Cheng-Liang Zhang  2 , Yan-Ying Duan  3
Affiliations
Observational Study

Wider intraoperative glycemic fluctuation increases risk of acute kidney injury after pediatric cardiac surgery

Guo-Huang Hu et al. Ren Fail. 2018 Nov.

Abstract

Objective: The association between poor intraoperative glycemic control and postoperative acute kidney injury (AKI) in adult cardiac surgery has been observed, but data in the pediatrics remain unknown. We performed a hypothesis that intraoperative hyperglycemia and/or wider glycemic fluctuation were associated with the incidence of postoperative AKI in pediatric cardiac surgery.

Methods: A retrospective study was performed in pediatrics who underwent cardiac surgery from 2013 to 2016. Perioperative glycemic data up to 48 hours after surgery were collected and analyzed. Patients with AKI were matched 1:1 with patients without AKI by a propensity score. Variables of demographic data, preoperative renal function and glycemic level, perioperative cardiac condition were matched.

Results: The incidence of AKI was 11.5% (118/1026), with 53.4% (63/118), 30.5% (36/118), and 16.1% (19/118) categorized as AKIN stages I, II, and III, respectively. Children who experienced AKI were younger and cyanotic, underwent more complex surgeries, had higher peak intraoperative glucose levels, wider intraoperative glycemic fluctuation, greater inotropic scores and more transfusions, and poor outcomes (all p < .05). After matching, the AKI group had significantly wider intraoperative glycemic fluctuation (p < .05). Logistic regression showed intraoperative glycemic fluctuation was one of the risk factors for AKI (p = .033) and degree of AKI severity stage increased when the glycemic fluctuation increased (p < .01).

Conclusions: Wider intraoperative glycemic fluctuation, but not hyperglycemia, was associated with an increased incidence of postoperative AKI after pediatric cardiac surgery.

Keywords: Acute kidney injury; cardiac surgery; glycemic fluctuation; intraoperative; pediatric.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Intraoperative glycemic fluctuation and postoperatvie AKI (linear trend, p = .000). AKI: acute kidney injury; AKIN: acute kidney injury network.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Mendez CE, Der Mesropian PJ, Mathew RO, et al. . Hyperglycemia and acute kidney injury during the perioperative period. Curr Diab Rep. 2016;16:10. - PubMed
    1. Vanhorebeek I, Gunst J, Ellger B, et al. . Hyperglycemic kidney damage in an animal model of prolonged critical illness. Kidney Int. 2009;76:512–520. - PubMed
    1. Ryutaro H, Xu F, Dang K, et al. . Transient hyperglycemia affects the extent of ischemia-reperfusion-induced renal injury in rats. Anesthesiology. 2008;108:402–414. - PubMed
    1. Cherney DZJ, Scholey JW, Sochett E, et al. . The acute effect of clamped hyperglycemia on the urinary excretion of inflammatory cytokines/chemokines in uncomplicated type 1 diabetes: a pilot Study. Diab Care. 2011;34:177–180. - PMC - PubMed
    1. Patrick L, Van Vlem B, Coddens J, et al. . Tight perioperative glucose control is associated with a reduction in renal impairment and renal failure in non-diabetic cardiac surgical patients. Crit Care. 2008;12:R154. - PMC - PubMed

Publication types

MeSH terms