SA JOURNAL OF DIABETES & VASCULAR DISEASE RESEARCH ARTICLE VOLUME 20 NUMBER 2 • NOVEMBER 2023 27 haemodilution, significant changes in intravascular volume, mechanical trauma to blood cells and more blood loss due to impaired coagulation status as a result of hypothermia.21 However, in the same study, although the number of patients who developed acute renal failure was higher in the on-pump group, no statistically significant difference was found between the two groups. In our study, there was no difference between the groups in terms of drainage and blood product replacement. Therefore, it is not possible to say that drainage and blood products were effective in terms of creatinine elevation in this study. Further studies with larger numbers of patients are needed. Changes in serum creatinine levels are the most widely used method of monitoring renal dysfunction.22 One of the major limitations of our study was that renal function was followed by only serum creatinine monitoring. More detailed studies on this topic are underway. The small number of patients and the inclusion of isolated CABG surgery patients are further limitations of this study. Conclusion It is well known that DM is one of the causes of kidney failure. This study showed that creatinine levels increased in the DM group after CABG surgery was performed in patients with LLVEF, which is also a risk factor for kidney failure. We believe that careful postoperative follow up in this group of patients could reduce the risk of permanent haemodialysis. It is predicted that minimal changes in creatinine levels after surgery, which means a small impairment in renal function, may have a negative effect on the outcome. Efficient follow up in the early postoperative period, recognising these changes, and taking precautions may lead to positive results. this operation have DM.12 DM, LLVEF and renal dysfunction are some of the most important factors that increase mortality and morbidity rates in patients undergoing CABG surgery. So what happens to patients with risk factors such as DM and LLVEF? There is a wealth of data that can be used to draw beneficial conclusions for patients. Guidelines recommend that CABG surgery should be performed in appropriate patients with the above risk factors, as total revascularisation can be achieved.13 As mentioned above, patients with LLVEF are at risk of renal failure, and CABG surgery in these patients increases this risk. It is well known that renal hypoperfusion and inflammatory damage caused by CPB via complex mechanisms are the causes of renal failure.5 The reported incidence of AKI associated with cardiac surgery varies between five and 42%, depending on the population studied.14 In patients undergoing CABG surgery, AKI developed in 26% of patients with LLVEF, and this is of course much more common in patients with DM.15 In the present study, serum creatinine levels were found to increase in the postoperative period in all patients undergoing CABG surgery in patients with pre-operative LLVEF < 35%. The study compared DM and non-DM control groups and although the percentage of AKI was numerically higher in the DM group, this did not reach statistical significance. However, there was a statistically significant increase in creatinine level change on days 2 and 5 postoperatively in the DM group. AKI is a common complication after cardiac surgery, prolonging ICU stay and hospitalisation.16 In their study of 1 881 patients undergoing open-heart surgery, Bastin et al.17 reported that AKI developed in 25.9% of patients, according to the AKIN classification. Sampaio et al.18 found that AKI developed in 51%, according to the AKIN classification. In the present study, the rate of AKI was found to be 29% in all patients, which is consistent with the literature. In addition, the length of stay in ICU was found to be statistically significantly longer in the DM group, with markedly higher serum creatinine levels than in the control group. This is also in line with the literature. Renal dysfunction and atrial fibrillation, which require balanced postoperative haemodynamics, fluid management, and good treatment and monitoring, were considered to be factors prolonging the ICU stay of patients in our study. DM is an independent risk factor for renal failure. The need for haemodialysis in the postoperative period, and mortality and morbidity associated with renal complications in diabetic patients ranged from28–63% in various studies andwere significantly higher than in non-DM patients.19 In the present study, the percentage of AKI was found to be higher in the DM group, in line with the literature. However, this rate was not statistically significant when compared to the control group. Cross-clamp times are prolonged in DM patients because of the high number of bypassed vessels. Although studies have shown a correlation between cross-clamp times and creatine elevation, no correlations were found between cross-clamp time and postoperative creatinine elevation in our study.20 We believe that the reason for this is the limited number of patients. Excessive amounts of blood transfusion, which is also considered to be tissue transplantation, causes more renal dysfunction and, of course, high morbidity and mortality rates. In a study comparing off- and on-pump CABG surgery, it was found that post-operative haematocrit levels were lower and amount of transfused blood products were higher in the on-pump group, associated with DYNA-PENTOXIFYLLINE SR. Each slow release tablet contains 400 mg pentoxifylline. S2 36/8/0282. NAM NS1 08/8/0183. For full prescribing information, refer to the professional information approved by SAHPRA, 11 December 2004. 1) Hood SC, Moher D, Barber GG. Management of intermittent claudication with pentoxifylline: meta-analysis of randomized controlled trials. CMAJ 1996 Oct 15;155(8):1053-9. DPEB1084/09/2023 CUSTOMER CARE LINE +27 21 707 7000 www.pharmadynamics.co.za solve a sticky situation Your cardiovascular patients face a dilemma. Hood SC, et al., reported that they can’t walk because of pain, but walking is exactly what they need to do.1 Oer them Dyna-Pentoxifylline SR 400 mg for the symptomatic relief of intermittent claudication, trophic ulcers and Raynaud’s syndrome.
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