Preoperative Volume Replacement vs. usual care in Diabetic patients having CABG surgery: a randomised controlled trial

Diabetes mellitus is a major risk factor for complications in patients having coronary artery bypass graft (CABG) surgery. Such complications pose a serious threat to patients and prolong intensive care and hospital stay. Renal failure is more common after coronary artery bypass grafting in diabetics than in non-diabetics. Volume depletion is associated with a low glomerular filtration rate, and may lead to acute renal impairment/failure.

Preoperative volume replacement therapy is reported to increase the glomerular filtration rate and we hypothesised that this would reduce renal impairment.

VeRDiCT was designed to test whether diabetic patients randomised to pre-operative volume replacement would have less problems with renal impairment after surgery. The study recruited patients from the Bristol Royal Infirmary, and ran in parallel with a study in India.

Patients who consented to take part in VeRDiCT were allocated to either standard care or to volume replacement therapy, which meant receiving an intravenous drip of Hartmann’s solution for about 12 hours before their operation. Standard care meant that the patients only had volume replacement if it was needed for another clinical reason. Numerous samples of blood and urine were collected during the patient’s stay in hospital and information about the patient’s health on the day that they left hospital was recorded. Patients were followed up by telephone call 6-8 weeks after surgery to assess their wounds and answer questions regarding readmissions, and then again by questionnaire 3 months after surgery to assess their health status and health resource usage.

Recruitment went well and data analysis has been completed. The study results have been written up and were published in the journal Interactive CardioVascular and Thoracic Surgery

The study was funded by the Garfield Weston Trust (Ref: PMS/MMS-07/08-3001), and supported by the NIHR Bristol Cardiovascular Biomedical Research Unit and the British Heart Foundation.

VeRDiCT protocol paper

Contact Information

Chief Investigator: Prof Raimondo Ascione