Poor results after cardiac surgery are more common in patients with end-stage renal disease (ESK) on dialysis than in the non-dialysis population. However, according to Elias Bassil, MD, and colleagues, there is little data available on the impact of dialysis modality and type of cardiac surgery.
During a virtual poster session at ASN Kidney Week 2021, researchers presented the results of an outcome analysis in patients with ESKD on hemodialysis or peritoneal dialysis undergoing coronary artery bypass grafting and / or heart valve surgery. The poster was titled Results of ESKD Patients on Hemodialysis Compared to Peritoneal Dialysis After Open Heart Surgery.
A total of 590 patients with ESK on hemodialysis or peritoneal dialysis who underwent coronary artery bypass grafting and / or cardiac valve surgery at the Cleveland Clinic (Ohio) from 2009 to 2019 were identified using the registry of cardio-thoracic surgery based on electronic health records. Chi-square was used to compare baseline demographics between the hemodialysis group and the peritoneal dialysis group; T tests for categorical and continuous variables were used to compare baseline comorbidities. The Kruskal-Wallis test, chi-square, and Fisher’s exact tests were used to compare hospital deaths, length of hospital stay, length of intensive care unit stay, blood transfusions. required red blood cells and the incidence of postoperative complications, including pericardial effusions requiring intervention, gastrointestinal bleeding and sternal wound infections.
Of the 590 patients, 11% (n = 62) received peritoneal dialysis and 89% (n = 528) received intermittent hemodialysis; 47% (n = 277) had valve surgery only, 26.7% (n = 158) had coronary artery bypass graft only, and 26.3% (n = 155) had combined coronary artery bypass grafting.
Dialysis modality groups were similar in terms of baseline characteristics and comorbidities. Among patients undergoing coronary artery bypass grafting only, patients in the peritoneal dialysis group had more pericardial effusion (12.5% vs. 2.3%; P= 0.048) and more gastrointestinal bleeding (12.5% vs. 2.2%; P= .046) than patients in the hemodialysis group.
The dialysis groups were similar in terms of hospital mortality, length of hospital stay, length of ICU stay, and sternal wound infections in the different surgeries. After surgery, 16 peritoneal patients were converted to hemodialysis; an intention-to-treat analysis was applied for these patients.
In conclusion, the authors said: “In patients on maintenance dialysis, patients who underwent coronary artery bypass grafting, valve surgery, and combined surgery had similar results. Patients on peritoneal dialysis appeared to have more gastrointestinal bleeding and pericardial effusions requiring intervention in the coronary artery bypass graft group.
Source: Bassil E, Matta M, Liaqat A, et al. Results of ESKD patients on hemodialysis vs peritoneal dialysis after open heart surgery. Abstract of a poster presented at the American Society of Nephrology virtual Kidney Week 2021 (Abstract PO0879), November 2021.