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Ann Thorac Surg 1998;65:1588-1593
© 1998 The Society of Thoracic Surgeons

Original articles: cardiovascular

Hyperglycemia During Normothermic Cardiopulmonary Bypass: The Role of the Kidney

Hal Braden, MDa, Surinder Cheema-Dhadli, PhDb, C. David Mazer, MDa, David J. McKnight, MDa, William Singer, MDb, Mitchell L. Halperin, MDb

a Department of Anesthesia, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
b Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada

Accepted for publication January 9, 1998.

Address reprint requests to Dr Mazer, Department of Anesthesia, St. Michael’s Hospital, 30 Bond St, Toronto, Ont M5B 1W8 Canada
e-mail: (mazerd{at}smh.toronto.on.ca)

Background. Hyperglycemia commonly occurs during cardiopulmonary bypass. We studied the quantitative impact of glucose input and its renal excretion on hyperglycemia during cardiopulmonary bypass.

Methods. The quantity of glucose infused and metabolite and hormone concentrations in plasma, as well as oxygen consumption, carbon dioxide production, and renal glucose excretion, were determined before, during, and after cardiopulmonary bypass in 8 patients.

Results. Hyperglycemia (14 to 29 mmol/L) was accompanied by an increase in plasma insulin levels. The degree of hyperglycemia was directly related to the amount of glucose infused. The rate of oxygen consumption did not decrease and the rate of urea appearance (gluconeogenesis) did not rise. Despite a very high filtered load of glucose, there was very little glucosuria, indicating a markedly enhanced renal absorption of glucose.

Conclusions. Hormonal and metabolic factors permit the development of hyperglycemia during cardiopulmonary bypass but its severity depends on the quantity of glucose infused and, what appears to be a new finding, a markedly enhanced renal reabsorption of filtered glucose. Thus the kidney plays an important role in the development of severe hyperglycemia during cardiopulmonary bypass.




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