Acute kidney disease and postoperative glycemia variability in patients undergoing cardiac surgery: A multicenter cohort analysis of 8,090 patients

Lihai Chen; Jie Sun; Siyu Kong; Qilian Tan; Xuesheng Liu; Yi Cheng; Fan Yang; Xuan Yin; Chen Zhang; Jiacong Liu; Lanxin Hu; Yali Ge; Hongwei Shi; Jifang Zhou

doi:10.1016/j.jclinane.2024.111706

Acute kidney disease and postoperative glycemia variability in patients undergoing cardiac surgery: A multicenter cohort analysis of 8,090 patients

J Clin Anesth. 2025 Jan:100:111706. doi: 10.1016/j.jclinane.2024.111706. Epub 2024 Nov 26.

Authors

Lihai Chen¹, Jie Sun², Siyu Kong³, Qilian Tan¹, Xuesheng Liu⁴, Yi Cheng³, Fan Yang³, Xuan Yin³, Chen Zhang¹, Jiacong Liu¹, Lanxin Hu¹, Yali Ge¹, Hongwei Shi¹, Jifang Zhou⁵

Affiliations

¹ Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China.
² Department of Anesthesiology, Zhongda Hospital, Southeast University, Nanjing, China.
³ School of International Business, China Pharmaceutical University, Jiangsu, China.
⁴ Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China.
⁵ School of International Business, China Pharmaceutical University, Jiangsu, China. Electronic address: [email protected].

PMID: 39602857
DOI: 10.1016/j.jclinane.2024.111706

Abstract

Background: No previous research has specifically investigated the relationship between postoperative glycemic variability (GV) and acute kidney disease (AKD) in patients undergoing cardiac surgery. In this study, several methods of modelling postoperative GV were used to examine the association between GV and AKD risk and subtypes of AKD.

Methods: We undertook a retrospective study involving a total of 8,090 adult patients from three academic medical centers in Eastern China who underwent cardiac surgery with cardiopulmonary bypass between 2015 and 2023. Seven-day postoperative GV was calculated using the standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE), average daily risk range (ADRR), and time out of target range (TOR). The primary focus was on the occurrence of AKD between 8 and 90 days post-surgery, which was further categorized into persistent AKD and delayed AKD depending on the acute kidney injury (AKI) status in the first 7 days.

Results: During the 8-90 days postoperative period, AKD occurred in 522 out of 8,090 patients (6.5%). Seven-day postoperative GV was significantly and consistently higher in the AKD group (p<0.001 for each metric). After adjusting for relevant covariates, 7-day GV metrics were significantly associated with elevated AKD risk (standardized hazard ratio (SHR):1.20 (95% confidence interval (CI): (1.12 - 1.27) for SD; SHR: 1.30 (95% CI: 1.20 - 1.40) for TOR). GV was correlated with persistent AKD, while no statistically significant association was observed between GV and delayed AKD. Unique cutoff thresholds were calculated for each GV metric to provide a quantitative indicator of high GV, enhancing its practical utility.

Conclusions: Our study highlights the association between postoperative GV and increased AKD risk, and identifies specific GV thresholds in adults undergoing cardiac surgery.

Keywords: Acute kidney disease; Cardiac surgery; Cardiopulmonary bypass; Glycemic variability; Postoperative complications.

Publication types

Multicenter Study

MeSH terms

Acute Kidney Injury* / blood
Acute Kidney Injury* / epidemiology
Acute Kidney Injury* / etiology
Aged
Blood Glucose* / analysis
Cardiac Surgical Procedures* / adverse effects
Cardiopulmonary Bypass / adverse effects
China / epidemiology
Female
Humans
Hyperglycemia / blood
Hyperglycemia / diagnosis
Hyperglycemia / epidemiology
Hyperglycemia / etiology
Male
Middle Aged
Postoperative Complications* / blood
Postoperative Complications* / epidemiology
Postoperative Complications* / etiology
Postoperative Period
Retrospective Studies
Risk Factors

Substances

Blood Glucose