RENAL FUNCTION AFTER CORONARY BYPASS SURGERY IN PATIENTS WITH PRE-DIABETES

Aim. To reveal the predictors of renal dysfunction due to surgical revascularization of myocardium in stable angina patients with prediabetes.

Material and methods. Totally, 48 patients with prediabetes studied, having indications for coronary bypass grafting (CBG) at the age 60±7,4 years with coronary heart disease (CHD) anamnesis 6±5,4 years. Multivessel disease of coronary vessels had 68,8% of patients, LCA stem stenosis >50 % had 10,9% of patients. On-pump CBG was done in 87,5% of patients, off-pump — 12,5%. Duration of on-pump period was 95±23 min., number of distal anastomoses for one patient — 2,8±0,8. Baseline, on the first and second days post-CBG, and if needed later, the creatinin concentration was measured in the blood, as glomerular filtration rate (GFR) by CKD-EPI equation. Of the development of renal dysfunction in CBG we decided if GFR decreased below 60 mL/min/1,73 m2 . In statistics we took continuous variables as М±SD and as Me (25%–75%) depending on the type of distribution. Renal dysfunction predictors were defined with the method of staged regression.

Results. In patients with stable angina and prediabetes we found moderate transient decrease of GFR after CBG comparing to the baseline level with Me 89,4 (78-105) to Ме 77,8 (59-96) mL/min/1,73 m2 (р<0,01). Significant decrease of GFR after CBG had the patients with in-hospital complications (introperational myocardial infarction, acute heart failure, atrial fibrillation paroxysm) — Ме 92 (82-107) and Ме 72,4 (56-89) mL/min/1,73 m2 , р=0,000 differ from the patients groups not having complications, р=0,797. The part of persons developing CBG related renal dysfunction was 21,7%. Decrease of GFR <60 mL/min/1,73 m2 after CBG is associated with older age, lower baseline GFR and longer on-pump period.

Conclusion. Among patients with stable angina and pre-diabetes the part of those developing CBG related renal dysfunction was 21,7%. The increase of on-pump time more than Me 105 (86-136) minutes significantly increased the relative risk of renal dysfunction development after CBG.

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