Affiliation:
1. Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS), Kolkata, India
2. Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
3. Faculty of Health Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
Abstract
Abstract
OBJECTIVES
To investigate the effect of preoperative volume replacement therapy (VRT) on renal function, health outcome and time to fitness for discharge in diabetic patients undergoing coronary artery bypass grafting (CABG).
METHODS
In 2 parallel randomized controlled trials, diabetic patients were allocated to preoperative VRT (1 ml/kg/h of Hartmann’s solution for 12 h) or usual care. Primary outcome was time to fitness for discharge. Secondary outcomes included acute kidney injury, postoperative complications, patient-reported quality of life (QoL), hospital resource use and markers of renal, cardiac and inflammatory injury.
RESULTS
In total, 169 patients were randomized (84 VRT, 85 usual care; mean age 64 years; 88% male). Time to fitness for discharge was similar between groups [median 6 days; interquartile range 5.0–9.0 in both groups; hazard ratio 0.95, 95% confidence interval (CI) 0.65–1.38; P = 0.78]. Postoperative acute kidney injury was not statistically different (VRT: 27.7% vs usual care: 18.8%, odds ratio 1.72, 95% CI 0.82–3.59; P = 0.15). Estimated glomerular filtration rate (mean difference −0.92, 95% CI −4.18 to 2.25; P = 0.56), microalbumin/creatinine ratio [geometric mean ratio (GMR) 1.16, 95% CI 0.94–1.42; P = 0.16], N-acetyl-beta-d-glucosaminidase (GMR 1.08, 95% CI 0.83–1.40; P = 0.57), C-reactive protein (GMR 1.00, 95% CI 0.88–1.13; P = 0.94), troponin T (Trop-T; GMR 1.18, 95% CI 0.78–1.79; P = 0.39) and other secondary health outcomes were similar between groups. QoL improved in both groups at 3 months with no difference observed.
CONCLUSIONS
The use of preoperative VRT is not superior to usual care in diabetic patients undergoing CABG.
Clinical trial registration number
ISRCTN02159606.
Funder
Garfield Weston Trust
NIHR Bristol Cardiovascular Biomedical Research Centre
Publisher
Oxford University Press (OUP)
Subject
Cardiology and Cardiovascular Medicine,Pulmonary and Respiratory Medicine,Surgery
Cited by
2 articles.
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