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Does preoperative homocysteine level influence the kidney functions after coronary artery bypass grafting?
Anna Marcinkiewicz1, Aleksandra Ryk2, Wojciech Wiese3,4
1Department of Cardiac Surgery, Medical University of Lodz, ul. Pomorska 251, Lodz, Poland. anna.marcinkiewicz@umed.lodz.pl.
Insights
Elevated homocysteine (Hcy) is linked to kidney complications after coronary artery bypass grafting (CABG). This study suggests Hcy may be a biomarker for acute kidney injury (AKI) or chronic kidney disease (CKD) exacerbation post-CABG.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Biomarkers
Background:
- Elevated homocysteine (Hcy) is associated with endothelial dysfunction and cardiovascular issues.
- The role of Hcy in postoperative complications, particularly acute kidney injury (AKI) following coronary artery bypass grafting (CABG), requires further definition.
- Diabetes mellitus is a known risk factor for AKI and chronic kidney disease (CKD) exacerbation, potentially influencing these outcomes post-CABG.
Purpose of the Study:
- To investigate the association between preoperative homocysteine (Hcy) levels and postoperative renal complications (AKI or CKD exacerbation) in patients undergoing CABG.
- To explore the correlation of Hcy with other perioperative complications, including myocardial injury, infections, and neurological or respiratory issues.
- To evaluate Hcy as a potential biomarker for renal complications after CABG, considering the impact of type 2 diabetes mellitus (T2DM).
Main Methods:
- Prospective analysis of 66 patients (27 with T2DM, 39 controls) undergoing elective CABG with extracorporeal circulation.
- Primary outcome: occurrence of postoperative AKI or CKD exacerbation. Secondary outcomes: correlation of Hcy with perioperative myocardial injury, infections, and neurological/respiratory complications.
- Statistical analysis included Spearman's correlation for Hcy and laboratory parameters, and logistic regression for associations with complications.
Main Results:
- Preoperative Hcy levels were similar between T2DM patients and controls (12.6 vs. 12.1 µmol/L).
- Hcy positively correlated with triglycerides, C-peptide, and CRP, and negatively with HDL cholesterol.
- Higher preoperative Hcy levels were significantly associated with postoperative AKI or CKD exacerbation (p=0.0013).
Conclusions:
- Elevated preoperative homocysteine (Hcy) levels are associated with an increased risk of renal complications after CABG.
- Hcy may serve as a valuable predictive biomarker for identifying patients at risk of AKI or CKD exacerbation post-CABG.
- Further research is warranted to explore therapeutic strategies targeting Hcy to mitigate renal complications in CABG patients.
Background:
Elevated homocysteine (Hcy) has been linked to endothelial dysfunction and adverse cardiovascular outcomes. However, its specific role as a risk factor for postoperative complications, especially acute kidney injury (AKI), in patients undergoing coronary artery bypass grafting (CABG), remains insufficiently defined. What's more we took into consideration presence of diabetes mellitus as an independent risk factor of AKI or the exacerbation of pre-existing chronic kidney disease (CKD), what can modify the prevalence of this complication.
Methods:
We conducted a prospective analysis of 66 patients (27 with T2DM, 39 controls) who underwent elective CABG with extracorporeal circulation. The study population consisted mainly of men (82,5%), the median age was 69 years. The majority of patients had preserved good left ventricle function. The primary outcome was the occurrence of postoperative AKI or the exacerbation of pre-existing CKD after CABG. We also analyzed the correlation of preoperative homocysteine level with perioperative myocardial injury, infections, neurological or respiratory complications. Clinical, biochemical, and postoperative data were collected for all participants. Spearman's correlation assessed associations between Hcy and laboratory parameters, while univariable and multivariable logistic regression examined relationships with complications.
Results:
Preoperative median Hcy levels were similar in T2DM patients and controls (12.6 vs. 12.1 µmol/L, p = 0.24). In the total cohort, Hcy showed positive correlations with triglycerides (r = 0.39, p = 0.0018), C-peptide (r = 0.33, p = 0.0086), and CRP (r = 0.29, p = 0.0210), and a negative correlation with HDL cholesterol (r = - 0.31, p = 0.0149). Higher Hcy levels were significantly associated with acute kidney injury (AKI) or exacerbation of chronic kidney disease (CKD) after CABG (b = 7.14, SE = 2.11, b⁎ = 0.40, p = 0.0013).
Conclusion:
Elevated preoperative Hcy levels were associated with postoperative renal complications after CABG. Therefore, Hcy may serve as a potential biomarker of AKI or exacerbation of CKD after CABG.
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