12 Sep Kidney Injury after Heart Surgery Greater For Type 1 than Type 2 Diabetes

MedicalResearch.com Interview with:
Dr. Daniel Hertzberg M.D., Ph.D. Student
Department of Medicine, Solna
Karolinska University Hospital

Medical Research: What is the background for this study?

Dr. Hertzberg: Acute Kidney Injury (AKI) is a common complication in patients undergoing cardiac surgery. It is associated with increased short and long-term mortality, myocardial infarction, heart failure and chronic kidney disease. Diabetes is often considered as a risk factor for AKI. However, when we searched the literature we did not find any studies which specifically studied diabetes as a risk factor for AKI. In addition, in observational studies, it is uncommon that diabetes is subtyped into type 1 or type 2 even though they have different etiologies and thus may have different impact on risk of adverse outcomes. Thus, we designed this study in order to study the association between the two subtypes of diabetes and risk of AKI.

Medical Research: What should clinicians and patients take away from your report?

Dr. Hertzberg: Patients with type 1 diabetes mellitus and patients with type 2 diabetes mellitus have an increased risk of AKI. However, the risk for acute kidney Injury associated with type 1 diabetes is several-fold higher than the risk for patients with type 2 diabetes. Clinicians should be aware of this when patients with diabetes undergo investigations or treatments associated with AKI. Alternative methods or drugs should be considered. Preventive actions such as adequate hydration is also recommended.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Hertzberg: The study underlines the importance of including information on diabetes in studies on acute kidney Injury in cardiac surgery. We also strongly believe that it is important to subtype diabetes since the risk associated with type 1 diabetes is much stronger than the risk associated with type 2 diabetes. We believe that the importance of preoperative glycemic control (hemoglobin A1 c levels) for the risk of AKI would be of interest to investigate. Is it the subtype of diabetes per se which is associated with an increased risk of AKI, or is the reason for the stronger association found in patients with type 1 compared to type 2 diabetes that they commonly have higher levels of hemoglobin A1 c? If this would be the case, this would open up for a randomized control trial where strict glycemic control would be the intervention to prevent AKI.

Citation:

Type 1 and type 2 diabetes mellitus and risk of acute kidney injury following coronary artery bypass grafting

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Last Updated on September 12, 2015 by Marie Benz MD FAAD