Regarding long-term survival, the 1-year Kaplan–Meier survival curves for HD and PD patients revealed that most PD patients (66.7%) died in the first year, whereas HD patients had a 56.6% overall survival rate (P = .031; Fig. 2).
Taiwan is an epidemic area for ESRD, with highest incidence and prevalence rates in the recent decades, and most of the ESRD cases occur secondary to diabetes mellitus (DM) in Taiwan.[17,19] Poorly controlled DM and its complications often progress to cardiovascular disease and dialysis dependence, thus making health care difficult and incurring enormous economic costs. Compared with the general population, cardiovascular complications are <3 times more common in ESRD patients.[8,21,22] Unfortunately, in most preoperative evaluation systems, ESRD is a risk factor for open heart surgery.[23–25] Although CABG surgery is preferred to PCI,[26–28] the risk stratification, postoperative complications, and short-term outcomes of CABG remain issues that need to be resolved by clinicians.
Different distributions of in-hospital mortality causes were observed between HD and PD patients. In HD patients, the main mortality cause was cardiac events, which may be due to the frequent hemodynamic fluctuations and increased cardiac loading caused by HD, whereas PD patients mostly died of septic shock, which may reflect the fact that they were more easily infected. According to these results, we suggest that PD patients should receive more aggressive infection control, and more attention should be given to the hemodynamics and heart failure signs while taking care of HD patients.
This study has some limitations that should be noted while interpreting the results. First, this was a single-center retrospective study of a relatively small population in Asia; thus, selection bias and regional and ethnic differences may have existed, and these results should not be directly extrapolated to other patient populations. Second, the relatively high mortality in this study reflects real-world data from areas outside developed Western countries and is compatible with our national data of CABG in Taiwan. The low medical expenditure for admissions in Taiwan (approximately 10% of the costs in the United States) may have negatively affected the outcomes of cardiac surgery. Postoperative care was not taken into consideration in this study, which may have affected the results. Finally, this study is limited by its post hoc analytical nature. However, this study may still add value to the current literature on dialysis patients undergoing cardiac surgery.
. Sarnak MJ, Levey AS. Epidemiology of cardiac disease in dialysis
patients. Semin Dial 1999;12:69–76.
. Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998;32:S112–9.
. Foley RN, Parfrey PS, Harnett JD, et al. Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney Int 1995;47:186–92.
. Bahar I, Akgul A, Demirbag AE, et al. Open heart surgery in patients with end-stage renal failure: fifteen-year experience. J Card Surg 2009;24:24–9.
. Hwang SJ, Tsai JC, Chen HC. Epidemiology, impact and preventive care of chronic kidney disease in Taiwan. Nephrol 2010;15(Suppl 2):3–9.
. Kogan A, Medalion B, Kornowski R, et al. Cardiac surgery in patients on chronic hemodialysis: short and long-term survival. Thorac Cardiovasc Surg 2008;56:123–7.
. Zimmet AD, Almeida A, Goldstein J, et al. The outcome
of cardiac surgery in dialysis
-dependent patients. Hear Lung Circ 2005;14:187–90.
. Foley RN, Parfrey PS. Cardiac disease in chronic uremia: clinical outcome
and risk factors. Adv Ren Replace Ther 1997;4:234–48.
. Koyanagi T, Nishida H, Kitamura M, et al. Comparison of clinical outcomes of coronary artery bypass grafting and percutaneous transluminal coronary angioplasty in renal dialysis
patients. Ann Thorac Surg 1996;61:1793–6.
. Liu JY, Birkmeyer NJ, Sanders JH, et al. Risks of morbidity and mortality in dialysis
patients undergoing coronary artery bypass surgery. Northern New England Cardiovascular Disease Study Group. Circulation 2000;102:2973–7.
. Rahmanian PB, Adams DH, Castillo JG, et al. Early and late outcome
of cardiac surgery in dialysis
-dependent patients: single-center experience with 245 consecutive patients. J Thorac Cardiovasc Surg 2008;135:915–22.
. Szczech LA, Reddan DN, Owen WF, et al. Differential survival after coronary revascularization procedures among patients with renal insufficiency. Kidney Int 2001;60:292–9.
. Zheng H, Xue S, Lian F, et al. Meta-analysis of clinical studies comparing coronary artery bypass grafting with percutaneous coronary intervention in patients with end-stage renal disease. Eur J Cardiothorac Surg 2013;43:459–67.
. Kumar VA, Ananthakrishnan S, Rasgon SA, et al. Comparing cardiac surgery in peritoneal dialysis
and hemodialysis patients: perioperative outcomes and two-year survival. Perit Dial Int 2012;32:137–41.
. Abraham G, Blake P, David T. Decreased morbidity in peritoneal dialysis
patients undergoing coronary artery bypass graft. Perit Dial Int 1989;9:355–6.
. Zhong H, David T, Zhang AH, et al. Coronary artery bypass grafting in patients on maintenance dialysis
: is peritoneal dialysis
a risk factor of operative mortality? Int Urol Nephrol 2009;41:653–62.
. Kuo HW, Tsai SS, Tiao MM, et al. Epidemiological features of CKD in Taiwan. Am J Kidney Dis 2007;49:46–55.
. Hillis LD, Smith PK, Anderson JL, et al. ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery. Circulation 2011;124:e652–735.
. Hwang SJ, Tsai JC, Chen HC. Epidemiology, impact and preventive care of chronic kidney disease in Taiwan. Nephrology 2010;15:3–9.
. Kao TW, Chang YY, Chen PC, et al. Lifetime costs for peritoneal dialysis
and hemodialysis in patients in Taiwan. Perit Dial Int 2013; 33:671–678.
. Cooper WA, O’Brien SM, Thourani VHG, et al. Impact of renal dysfunction on outcomes of coronary artery bypass surgery: results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation 2006;113:1063–70.
. Wison S, Foo K, Cunningham J, et al. Renal function and risk stratification in acute coronary syndromes. Am J Cardiol 2003;91:1051–4.
. Kunt AG, Kurtcephe M, Hidiroglu M, et al. Comparison of original EuroSCORE, EuroSCORE II and STS risk models in a Turkish cardiac surgical cohort. Interact Cardiovasc Thorac Surg 2013;16:625–9.
. Paparella D, Guida P, Di Eusanio G, et al. Risk stratification for in-hospital mortality after cardiac surgery: external validation of EuroSCORE II in a prospective regional registry. Eur J Cardiothorac Surg 2014;46:840–8.
. Gogbashian A, Sedrakyan A, Treasure T. EuroSCORE: a systematic review of international performance. Eur J Cardiothorac Surg 2004;25:695–700.
. Herzog CA, Ma JZ, Collins AJ. Comparative survival of dialysis
patients in the United States after coronary angioplasty, coronary artery stenting, and coronary artery bypass surgery and impact of diabetes. Circulation 2002;106:2207–11.
. Shroff GR, Solid CA, Herzog CA. Long-term survival and repeat coronary revascularization in dialysis
patients after surgical and percutaneous coronary revascularization with drug-eluting and bare metal stents in the United States. Circulation 2013;127:1861–9.
. Krishnaswami A, McCulloch CE, Tawadrous M, et al. Coronary artery bypass grafting and percutaneous coronary intervention in patients with end-stage renal disease. Eur J Cardiothorac Surg 2015;47:e193–8.
. Lai S, Molfino A, Russo GE, et al. Cardiac, inflammatory and metabolic parameters: hemodialysis versus peritoneal dialysis
. Cardiorenal Med 2015;5:20–30.
. Chen SW, Chang CH, Lin YS, et al. Effect of dialysis
dependence and duration on post-coronary artery bypass grafting outcomes in patients with chronic kidney disease: a nationwide cohort study in Asia. Int J Cardiol 2016;223:65–71.