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Preoperative VolumE Replacement therapy in DIabetic patients undergoing coronary artery bypass grafting surgery: results from an open parallel group randomized Controlled Trial (VeRDiCT)

Research output: Contribution to journalArticle

Original languageEnglish
Article numberivz226
Number of pages10
JournalInteractive Cardiovascular and Thoracic Surgery
DOIs
DateAccepted/In press - 23 Aug 2019
DatePublished (current) - 20 Sep 2019

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.

    Research areas

  • Coronary artery bypass grafting, diabetes mellitus, renal failure, volume replacement therapy

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Documents

  • Full-text PDF (author’s accepted manuscript)

    Rights statement: This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Oxford University Press at https://academic.oup.com/icvts/advance-article/doi/10.1093/icvts/ivz226/5572153 . Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 2 MB, PDF document

    Embargo ends: 20/09/20

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