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Abstract SUMMARY cute kidney injury is a frequent complication after cardiac surgery. According to the literature and the various definitions of acute kidney injury, cardiac surgery associated kidney injury may concern 1% to 30%of the patients. Mortality raises from 1% up to 50% for patients who undergo renal replacement therapy following cardiac surgery. Early detection of renal dysfunction is often presented as a ―holy grail‖ because it could allow interventions (both diagnostic and therapeutic) to prevent evolution to renal failure. Serum creatinine reflects the balance between the synthesis of creatinine and its excretion by the kidney. Creatinine production in the body varies with muscle mass, physical activity, protein intake, and catabolism while creatinine excretion is dependent on the glomerular filtration rate (GFR). The serum creatinine and GFR are inversely and exponentially related. Halving of GFR implies that there will be doubling of creatinine concentration. There are several limitations for creatinine as a marker of kidney injury in acute perioperative situations. However, it has a poor, predictive accuracy for kidney injury, particularly in the early stages of AKI. Currently the early prediction of AKI by clinical and laboratory methods remains difficult. In clinical practice creatinine level and urine output are the most frequently used indicators of renal dysfunction despite their limited sensitivity and specificity. A Summary 79 Several urinary proteins such as neutrophil gelatinaseassociated lipocalin (NGAL), cystatin C, kidney injury molecule-1 (KIM-1) and interleukin-18 (IL-18) have been studied to assess their role as early biomarkers of AKI in patients undergoing cardiac surgery. Hemoglobin A1c (HbA1c) is widely used as a marker of average blood glucose concentrations over the preceding 2 to 3 months and it has advantages over glucose tests. Some evidence indicates that high HbA1c levels prior to surgery are strongly associated with the severity of adverse events after CABG. HbA1c levels were found to be related to cardiovascular and renal complications following open heart surgery. Multiple factors have been implicated as contributors to postoperative AKI, including advanced age, female gender, presence of diabetes mellitus, chronic kidney disease, extended time between heart catheterization and surgery, aortic cross clamp time, duration of cardiopulmonary bypass (CPB), and blood transfusion following surgery. In this study we measured both HbA1c, serum creatinine, UOP and urinary neutrophil gelatinase associated lipocalin (NGAL) to predict acute kidney injury in patients undergoing elective CABG. Summary 80 After obtaining the approval of our institute, Hospitals ethical committee, informed consent was taken from 40 patients of ASA physical status II - III, aged 50-80 years, scheduled to undergo isolated coronary artery bypass grafting (CABG) in this prospective cohort study at Ain-Shams University Hospitals, from June 2019 until July 2020. This study was done as a prospective cohort study, in which 40 patients were divided into 2 equal groups who underwent isolated coronary artery bypass grafting (CABG). Patients with preoperative HbA1c 5.7-6.4% (group A) (prediabetics). Patients with preoperative HbA1c > or = 6.5% (group B) (diabetics). Primary Outcome: Acute kidney injury (AKI); diagnosis of postoperative AKI was made in accordance with the International Kidney Disease: Improving Global Outcomes (KDIGO) definition of AKI KDIGO Classification (Khwaja, 2012). AKI is defined as any of the following: increase in serum creatinine by ≥0.3 mg/dl within 48 hours of surgery or increase in serum creatinine to ≥1.5 times baseline within 3 days of cardiac surgery. Summary 81 Normal range of BUN, Cre, is accepted as 18-55 mg/dL, 0.7-1.2 mg/dl, respectively. Cut-off level for urinary NGAL 12 hours post- bypass is accepted as 65 ng/mL to determine postoperative AKI. The study revealed that: AKI following cardiac surgery causes multiple postoperative complications and leads to prolonged hospitalization, increased costs, and eventually increased mortality rates. This study revealed that elevated preoperative HbA1c level increase incidence of post CABG acute kidney injury along with length of postoperative ICU stay. |