Kidney Res Clin Pract.  2019 Sep;38(3):399-406. 10.23876/j.krcp.18.0123.

Outcomes of open heart surgery in patients with end-stage renal disease

• Park JH
• Lim JH
• Lee KH
• Jung HY
• Choi JY
• Cho JH
• Kim CD
• Kim YL
• Jung H
• Kim GJ
• Park SH

• KMID: 2457732
• DOI: http://doi.org/10.23876/j.krcp.18.0123

Abstract

BACKGROUND
Cardiovascular diseases of chronic dialysis patients are often undertreated because of their higher surgical risk. This study aimed to assess mortality and morbidity after open heart surgery in chronic dialysis patients compared to those with normal renal function and identify risk factors for postoperative outcomes.
METHODS
We retrospectively analyzed 2,432 patients who underwent open heart surgery from 2002 to 2017 and collected data from 116 patients (38 patients on dialysis and 78 age-, sex-, and diabetes mellitus status-matched control patients with normal kidney function). We assessed comorbidities, New York Heart Association (NYHA) class, laboratory data, surgical methods, and postoperative outcomes.
RESULTS
The dialysis group had more comorbidities, higher NYHA classes, and greater need for urgent surgeries compared to the control group. They exhibited significantly higher postoperative mortality (18.4% vs. 2.6%, P = 0.005) and more overall complications (65.8% vs. 25.6%, P < 0.001). Dialysis itself significantly increased relative risk for in-hospital mortality after adjustment. EuroSCORE II was not as useful as in the general population. Multivariate logistic regression analysis demonstrated that total (adjusted odds ratio [AOR], 10.7; P = 0.029) and in-hospital death risk (AOR, 14.7; P = 0.033), the durations of postoperative hospitalization (AOR, 4.6; P = 0.034), CRRT (AOR 36.8; P = 0.004), and ventilator use (AOR, 7.6; P = 0.022) were significantly increased in the dialysis group.
CONCLUSION
The dialysis group exhibited a higher risk for mortality and overcall complications after open heart surgery compared to the patients with normal renal function. Therefore, the benefit of surgical treatment must be balanced against potential risks.

Keyword

Cardiovascular disease; Dialysis; Renal insufficiency; Thoracic surgery

MeSH Terms

Cardiovascular Diseases
Comorbidity
Diabetes Mellitus
Dialysis
Heart*
Hospital Mortality
Hospitalization
Humans
Kidney
Kidney Failure, Chronic*
Logistic Models
Mortality
Odds Ratio
Renal Insufficiency
Retrospective Studies
Risk Factors
Thoracic Surgery*
Ventilators, Mechanical