CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 4, September/October 2023 198 AFRICA Cardiovascular Topics Association between carotid intima–media thickness and acute kidney injury following isolated coronary artery bypass surgery Çağrı Düzyol, Hüseyin Şaşkin Abstract Objective: The association between pre-operative carotid intima–media thickness (CIMT) and early postoperative acute kidney injury (AKI) following isolated coronary artery bypass grafting (CABG) was investigated. Methods: Data were sought retrospectively of 237 patients (166 male, 71 female; mean age 61.4 ± 8.1 years; range: 32–74), operated on for isolated CABG with cardiopulmonary bypass (CPB) in a single centre between June 2014 and December 2020, with a serum creatinine level < 1.5 mg/dl and normal carotid arteries on Doppler ultrasonography. AKI diagnosis was made according to the Kidney Disease Improving Global Outcomes 2012 Acute Kidney Injury Guideline. Patients were grouped as group 1 with AKI in the early postoperative period (n = 63) and group 2 without AKI (n = 174). Univariate analyses were done to determine significant clinical factors, and subsequent multiple logistic regression analysis was done to determine independent predictors of AKI. Results: AKI occurred in 63 (26.6%) patients. Pre-operative CIMT was significantly higher in the AKI group (p = 0.0001). Multivariate logistic regression analysis revealed that elevated pre-operative CIMT (p = 0.005), C-reactive protein (p = 0.001), erythrocyte sedimentation rate (p = 0.005), neutrophil–lymphocyte ratio (p = 0.0001) and platelet–lymphocyte ratio (p = 0.0001) increased on the postoperative seventh day. C-reactive protein (p = 0.04), postoperative first day platelet–lymphocyte ratio (p = 0.0001), postoperative seventh day erythrocyte sedimentation rate (p = 0.02) and intubation time (p = 0.02) were independent predictors of early postoperative AKI following isolated CABG. Conclusion: Pre-operative CIMT was found to be an independent predictor of AKI in the early postoperative period of isolated CABG. Keywords: coronary artery bypass grafting, acute kidney injury, carotid intima–media thickness Submitted 25/2/22, accepted 2/7/22 Published online 1/8/22 Cardiovasc J Afr 2023; 34: 198–205 www.cvja.co.za DOI: 10.5830/CVJA-2022-035 Cardiovascular disease is the main cause of mortality and morbidity in Western and developing countries.1 Endothelial dysfunction is the key to arteriosclerosis with disruption of endothelial homeostasis predisposing to vasoconstriction, inflammation, leukocyte adhesion, thrombosis and vascular smooth muscle cell proliferation.2 The atherosclerotic process results in increased carotid intima–media thickness (CIMT) as early structural change.3 CIMT has been proposed as a quantitative index of subclinical atherosclerotic disease progression and surrogate measures for cardiovascular disease.4 Elevated CIMT was reported as an atherosclerosis marker related to myocardial infarction, stroke and peripheral arterial disease.3 Moreover, CIMT is a parameter used to estimate other conventional vascular risk factors and events.5 CIMT increases in high-risk populations such as the elderly with hypertension, diabetes mellitus and chronic kidney disease.6 As an important pathology, acute kidney injury (AKI) often follows cardiac surgery, resulting in extended intensive care unit (ICU) and hospital stays, and increased expenses and mortality rates.7 The reported incidence of AKI following cardiac surgery is 5–30%.8 Multiple factors contribute to postoperative AKI, including advanced age, female gender, delay between cardiac catheterisation and surgery, aortic cross clamping (ACC) and cardiopulmonary bypass (CPB) duration, intra-operative mean arterial pressure differences and postoperative blood transfusion.9 Impaired endothelial function plays a central role in the pathogenesis of AKI.10 Renal dysfunction is known as one of the cardiovascular risk factors or markers that may improve risk prediction and identification in high-risk patients.4 Various biomarkers have recently been used to diagnose AKI as one of the important causes of morbidity and mortality in the early postoperative period of coronary artery bypass grafting (CABG). To date, the most studied and promising biomarkers have been neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), kidney injury molecule-1 and cystatin C.11 Liangos et al. reported that peri-operative plasma IL-8 levels predicted the occurrence Cardiovascular Surgery Clinic, Derince Training and Research Hospital, Health Sciences University, Kocaeli, Turkey Çağrı Düzyol, MD, cduzyol@hotmail.com Hüseyin Şaşkin, MD
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