Effect of On-Pump Versus Off-Pump Surgery on the Renal Function of Diabetic Patients: A Systematic Review

The effects of on-pump versus off-pump cardiac surgery on postoperative renal outcomes of diabetic patients remain unclear. Using prospective and retrospective clinical studies, we explored the impact of diabetic nephropathy (DN) on renal outcomes in this patient population. Additionally, we considered the impact of renal insufficiencies caused by DN on the renal outcome. We searched electronic databases using predetermined keyword combinations. A total of 8,083 studies were identified, of which 11 met the prespecified inclusion and exclusion criteria. The remaining nine observational studies and two randomised controlled trials were examined and extrapolated in the review matrix for critical analysis. The literature search generated 11 relevant studies, and the preoperative parameters were compared between the on-pump and off-pump groups in the studies to establish the influence of confounding variables. Statistically insignificant trends were identified, indicating a reduced incidence of renal failure and renal dysfunction in diabetic patients who underwent off-pump surgery. There was no difference in the outcome of severe renal failure requiring renal replacement therapy between the different surgical strategies. A trend favouring off-pump surgery was extrapolated in diabetic patients with preoperative renal insufficiency. We concluded that off-pump coronary artery bypass grafting (CABG) offers comparable long-term outcomes to on-pump CABG while demonstrating potential advantages in reducing perioperative complications, particularly in high-risk patients. However, further large-scale randomised trials are warranted to confirm these findings and guide individualised surgical decision-making.