101 DOES DIABETES MELLITUS INFLUENCE THE INCIDENCE AND OUTCOME OF ACUTE KIDNEY INJURY IN PATIENTS UNDERGOING CARDIAC SURGERY

Abstract

Category: Epidemiology and Outcomes from AKI Presenter: Dr KHENG WEE GOH Keywords: Acute Kidney Injury, Diabetes Mellitus, cardiac surgery Diabetes mellitus (DM) is one of the most prevalent disease in Malaysia. The National Health and Morbidity Survey (NHMS) 2015 estimated 17.5% (3.5 million) of adults 18 years and above have diabetes. DM is an established risk factor for coronary artery disease (CAD), and has been associated with an increased rate of adverse event after cardiac surgery. To examine and compare the incidence of acute kidney injury (AKI), renal recovery, length of hospital stay, and mortality rate between diabetic and non-diabetic patients who underwent cardiac surgery in our center. All patients who underwent cardiac surgery in our centre from 1.1.2014 to 31.12.2015 were included. AKI was defined based on KDIGO definition. All information was obtained from the electronic hospital information system (EHIS). A total of 758 patients were included in this study. Out of which 364 (48%) were diabetics with mean age of 54.5±11.1 years, and 562 (74%) were males. Five hundred and four patients (66.5%) underwent coronary artery bypass graft (CABG) surgery, 171 (22.6%) underwent valve surgery, 45 (5.9%) underwent combined CABG and valve surgery, and the remaining 38 (5%) had other types of surgery. Diabetics had higher incidence of stage 1 AKI (28.6% vs 26.9), and stage 3 AKI than non-diabetics (25.8% vs. 18.3%; p=0.031). More diabetics than non-diabetics (9% vs. 5.5%) failed to recover fully from AKI on discharge. Patients with diabetes were found to be generally older (57.2±8.3 years vs. 52±12.7 years; p<0.001), more were hypertensive (83.8% vs. 45.43%; p<0.001), more with left ventricle failure (EF < 35%) (10.99% vs. 4.31%; p<0.001) and with higher pre-operative creatinine (median 90.5μmol/L vs. median 79μmol/L; p<0.001). These observations probably explained the higher incidence of AKI among diabetic patients. Interestingly, mortality rate for diabetics and non-diabetics were comparable in our population (5.8% vs. 6.1%). There was also no significant difference in renal recovery and length of hospital stay. Patients with diabetes were found to be at higher risk of developing AKI after cardiac surgery. However, with appropriate management, the mortality rate, length of hospital stay, and renal recovery were comparable between diabetics and non-diabetics.