Our Summary

This study looked at the relationship between the thickness of the inner layers of the carotid artery (the artery in the neck that supplies blood to the brain) before surgery and the risk of developing acute kidney injury (sudden damage or failure of the kidneys) after undergoing coronary artery bypass grafting (a type of heart surgery).

Between June 2014 and December 2020, the researchers studied the medical records of 237 patients (mostly men, with an average age of around 61) who had undergone this type of heart surgery. The patients had normal levels of a certain protein (serum creatinine) in their blood and no abnormalities in their carotid arteries before surgery.

They divided the patients into two groups: those who had developed acute kidney injury shortly after surgery (63 patients) and those who had not (174 patients). They then looked at various factors to see which ones were associated with a higher risk of kidney injury.

Findings showed that 26.6% of patients developed acute kidney injury. Those with a thicker carotid artery before surgery were more likely to develop this complication. Other factors that increased the risk included higher levels of certain proteins and cells that indicate inflammation or infection in the body, longer time spent on a ventilator after surgery, and certain changes in blood cells and proteins on the first and seventh day after surgery.

In conclusion, the thickness of the carotid artery before surgery was found to be a predictor of acute kidney injury after coronary artery bypass grafting.

FAQs

  1. What is the association between pre-operative carotid intima-media thickness (CIMT) and early postoperative acute kidney injury (AKI) following isolated coronary artery bypass grafting (CABG)?
  2. What factors were found to be independent predictors of early postoperative AKI following isolated CABG?
  3. How prevalent was AKI in the patients studied who underwent isolated CABG?

Doctor’s Tip

A helpful tip a doctor might give a patient about heart bypass surgery is to maintain a healthy lifestyle before and after the procedure. This includes managing risk factors such as high cholesterol, high blood pressure, and diabetes, as well as staying physically active and following a balanced diet. Additionally, it is important to attend follow-up appointments and adhere to any prescribed medications to ensure optimal recovery and long-term heart health.

Suitable For

Patients who are typically recommended for heart bypass surgery are those with significant coronary artery disease that cannot be managed with medication or less invasive procedures such as angioplasty. This includes patients with multiple blocked arteries, severe chest pain (angina), and those at high risk for a heart attack. Additionally, patients with a history of previous heart procedures that have failed, or those with heart failure or decreased heart function may also be recommended for heart bypass surgery.

Timeline

  • Pre-operative period: Patients undergo pre-operative evaluations, including carotid ultrasound to assess carotid intima-media thickness (CIMT). Other pre-operative tests may include blood work, imaging studies, and consultations with various medical specialists.

  • Day of surgery: Patients undergo isolated coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). The surgery involves bypassing blocked arteries in the heart using blood vessels from other parts of the body.

  • Post-operative period: Patients are monitored closely in the intensive care unit (ICU) for any complications, including acute kidney injury (AKI). AKI is diagnosed based on the Kidney Disease Improving Global Outcomes 2012 Acute Kidney Injury Guideline.

  • Early postoperative period: AKI occurs in 26.6% of patients, with elevated pre-operative CIMT identified as a significant predictor of AKI. Other factors such as C-reactive protein, erythrocyte sedimentation rate, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and postoperative intubation time are also found to be independent predictors of AKI.

  • Subsequent days: Patients continue to be monitored for AKI and other postoperative complications. Factors such as C-reactive protein, platelet-lymphocyte ratio, erythrocyte sedimentation rate, and intubation time are identified as predictors of early postoperative AKI following isolated CABG.

Overall, pre-operative CIMT and other inflammatory markers play a significant role in predicting the risk of postoperative AKI in patients undergoing isolated CABG. Early detection and management of these risk factors can help improve outcomes for patients undergoing heart bypass surgery.

What to Ask Your Doctor

  1. How common is acute kidney injury (AKI) following coronary artery bypass grafting (CABG)?
  2. What are the risk factors for developing AKI after CABG?
  3. How is AKI diagnosed and monitored in the early postoperative period?
  4. What role does carotid intima-media thickness (CIMT) play in predicting AKI after CABG?
  5. Are there any specific tests or assessments that can help determine an individual’s risk for AKI before undergoing CABG?
  6. How can elevated levels of C-reactive protein, erythrocyte sedimentation rate, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio impact the likelihood of developing AKI after CABG?
  7. What measures can be taken to reduce the risk of AKI in patients undergoing CABG with elevated pre-operative CIMT?
  8. How does early postoperative AKI following CABG impact long-term outcomes and recovery?
  9. Are there any specific interventions or treatments that can help prevent or manage AKI in patients undergoing CABG?
  10. What follow-up care or monitoring is recommended for patients who have experienced AKI after CABG?

Reference

Authors: Düzyol Ç, Şaşkin H. Journal: Cardiovasc J Afr. 2023 Sep-Oct 23;34(4):198-205. doi: 10.5830/CVJA-2022-035. Epub 2022 Aug 1. PMID: 35913033