Cardiovascular disease is the major morbidity and leading cause of mortality for dialysis-dependent patients. This study aimed to stratify the risk factors and effects of dialysis modes in relation to coronary artery bypass grafting (CABG) surgery among dialysis-dependent patients.
This retrospective study enrolled dialysis-dependent patients who underwent CABG from October 2005 to January 2015. All data of demographics, medical history, surgical details, postoperative complications, and in-hospital mortality were analyzed, and patients were categorized as those with or without in-hospital mortality and those with preoperative hemodialysis (HD) or peritoneal dialysis (PD).
Of 134 enrolled patients, 25 (18.7%) had in-hospital mortality. Multivariate analyses identified that older age [odds ratio (OR): 1.110, 95% confidence interval (CI): 1.030–1.197, P = .006], previous stroke history (OR: 5.772, 95% CI: 1.643–20.275, P = .006), PD (OR: 19.607, 95% CI: 3.676–104.589, P < .001), and emergent operation (OR: 8.788, 95% CI: 2.697–28.636, P < .001) were statistically significant risk factors for in-hospital mortality among dialysis-dependent patients with CABG surgery. Patients with PD had a higher in-hospital mortality rate (58.3% vs 14.8%, P < .001) and lower 1-year overall survival (33.3% vs 56.6%, P = .031) than did HD patients. The major in-hospital mortality cause was cardiac events among HD patients and septic shock among PD patients.
Among dialysis patients who received CABG, those with older age, previous stroke history, PD, and emergent operation had higher risks. Those with PD were prone to poorer in-hospital outcomes after CABG surgery.
aDepartment of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
bGraduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University
cKidney Research Center, Department of Nephrology
dDepartment of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan, ROC.
Correspondence: Shao-Wei Chen, Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Hsing St, Kwei-Shan, Taoyuan, Taiwan 333, ROC (e-mail: Josephchen0314@gmail.com).
Abbreviations: CABG = coronary artery bypass grafting, CI = confidence interval, ESRD = end-stage renal disease, HD = hemodialysis, OR = odds ratio, PCI = percutaneous coronary intervention, PD = peritoneal dialysis.
HYL and CHC contributed equally to this work.
Authorship: HYL and SWC contributed to the conception of the study. HYL, SWC, and FCT participated in the design of the work. PJL, CCL, and CHC performed the data acquisition for the study. HYL and SWC performed the analysis and interpretation of data, literature search, and drafting of the work. PCT and PHC revised the manuscript and approved the final version of the article for submission. VCCW, DYC, and FCT contributed to critically revising the article for important intellectual content.
No additional investigators were involved in this research project.
Funding/support: This investigation and manuscript preparation received no external funding.
The datasets supporting the conclusions of this article are included within the article.
This post hoc analysis of prospectively collected data was approved by the institutional research bureau, who waived the need for individual consent.
The authors declare that they have no competing interest.
This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
Received June 17, 2017
Received in revised form August 24, 2017
Accepted August 31, 2017