Open AccessHaptoglobin 2‐2 Phenotype Is Associated With Increased Acute Kidney Injury After Elective Cardiac Surgery in Patients With Diabetes Mellitus
Author(s) -
Feng Chenzhuo,
Naik Bhiken I.,
Xin Wenjun,
Ma Jennie Z.,
Scalzo David C.,
Thammishetti Swapna,
Thiele Robert H.,
Zuo Zhiyi,
Raphael Jacob
Publication year - 2017
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.117.006565
Subject(s) - medicine , haptoglobin , acute kidney injury , diabetes mellitus , odds ratio , gastroenterology , cardiac surgery , incidence (geometry) , surgery , endocrinology , physics , optics
Background Recent studies reported an association between the 2‐2 phenotype of haptoglobin (Hp 2‐2) and increased cardiorenal morbidity in nonsurgical diabetic patients. Our goal was to determine whether the Hp 2‐2 phenotype was associated with acute kidney injury ( AKI ) after elective cardiac surgery in patients with diabetes mellitus. Methods and Results We prospectively enrolled 99 diabetic patients requiring elective cardiac surgery with cardiopulmonary bypass. Haptoglobin phenotypes were determined by gel electrophoresis. Cell‐free hemoglobin, haptoglobin, and total serum bilirubin were quantified as hemolysis markers. The primary outcome was postoperative AKI , as defined by the Acute Kidney Injury Network classification. The incidence of AKI was significantly higher in Hp 2‐2 patients compared with patients without this phenotype (non–Hp–2‐2; 55.6% versus 27%, P <0.01). The need for renal replacement therapy was also significantly higher in the Hp 2‐2 group (5 patients versus 1 patient, P =0.02). Thirty‐day mortality (3 versus 0 patients, P =0.04) and 1‐year mortality (5 versus 0 patients, P <0.01) were also significantly higher in patients with the Hp 2‐2 phenotype. In multivariable analysis, Hp 2‐2 was an independent predictor of postoperative AKI ( P =0.01; odds ratio: 4.17; 95% confidence interval, 1.35–12.48). Conclusions Hp 2‐2 phenotype is an independent predictor of postoperative AKI and is associated with decreased short and long‐term survival after cardiac surgery in patients with diabetes mellitus.