ACUTE KIDNEY INJURY AND ITS PROGNOSTIC VALUE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS UNDERGOING CORONARY ARTERY BYPASS GRAFTING

Abstract

THE AIM: to determine the frequency of acute kidney injury (AKI) and its prognostic value in patients with type 2 diabetes mellitus (DM) underwent coronary artery bypass grafting (CABG) with regard to initial renal function. PATIENTS AND METHODS. 358 patients (195 men and 163 women) aged from 48 till 67 years (61.7±6.3 years) were examined before and after CABG. Glomerular filtration rate (GFR) before operation was upper than 60 ml/min/1.73 m2 in 225 patients (62.8%) in the 1st group and ranged from 59 to 45 ml/min/1.73 m2 in 133 patients (37.2%) in the 2nd group. AKI was diagnosed by level of sCr using criteria of AKIN. RESULTS. Postoperative AKI was diagnosed in 29.8% patients of the 1st group and in 48.9% patients of the 2nd group (p<0,001). Cardiovascular complications have developed significantly more frequently in the 2nd group than in the 1st group. In-hospital mortality in the 1st group accounted for 3.1%, including patients with AKI (5.8%), in the 1st group and 6.1 and 9.2% in the 2nd group respectively. In long-term period chronic kidney disease (CKD) manifested in 14.9% of the patients with postoperative AKI in the 1st group. In the 2nd group regress of chronic kidney disease (CKD) was revealed in 46.2% of patients with postoperative AKI and in 55.4% of patients without previous history of AKI (p>0.05), however progressing of CKD was revealed in 10.8 and 5.9% of cases respectively (p>0.05). Late cardiovascular events, requiring hemodialysis and mortality were more frequent in the 2nd group than in the 1st group. CONCLUSION. It was revealed that the early and long-term cardiorenal prognosis in patients with a diabetic nephropathy underwent CABG and with postoperative AKI is much worse.