Skip to main content

Advertisement

SpringerLink
Log in

Coronary artery bypass grafting in patients on maintenance dialysis: Is peritoneal dialysis a risk factor of operative mortality?

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Background

Increasing numbers of patients on dialysis are undergoing coronary artery bypass grafting (CABG). We undertook this retrospective study to identify risk factors of operative mortality in dialysis patients who underwent CABG.

Patients and methods

We performed retrospective analysis of 105 patients who were on dialysis for at least two months before surgery and who underwent CABG in Toronto General Hospital from 1997 to 2006. Using prospectively collected data from the Division of Cardiovascular Surgery Database of Toronto General Hospital, we collected data on comorbidities, procedures, modality change during hospitalization, and operative outcomes. Logistic regression was used to assess risk factors of operative mortality.

Results

One hundred and five maintenance dialysis patients (40 PD and 65 HD) who met the inclusion criteria were studied. Overall in-hospital mortality was 7.6%. Atrial fibrillation and pneumonia occurred in 16.2 and 9.5%, respectively, of all dialysis patients. Among PD patients, rates of post-operative dialysate leak and peritonitis were 10 and 12.5%, respectively. Among HD patients, 4.6% experienced post-operative AV access thrombosis. Logistic regression showed older age (≥70 years) and peritoneal dialysis are independent risk factors of operative mortality.

Conclusion

In this retrospective study, older patients on PD had higher operative mortality than HD patients. These findings suggest extra care should be taken when CABG is considered for PD patients over 70 years old. In this study we could not identify the reason(s) for the high mortality of elderly peritoneal dialysis patients undergoing CABG.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. National Institutes of Health, USRDS (2006) 2006 annual data report, Bethesda, MD, p. 138

  2. Rinehart AL, Herzog CA, Collins AJ et al (1995) A comparison of coronary angioplasty and coronary artery bypass grafting outcomes in chronic dialysis patients. Am J Kidney Dis 25:281–290

    Article  PubMed  CAS  Google Scholar 

  3. Koyanagi T, Nishida H, Kitamura M et al (1996) Comparison of clinical outcomes of coronary artery bypass grafting and percutaneous transluminal coronary angioplasty in renal dialysis patients. Ann Thorac Surg 61:1793–1796

    Article  PubMed  CAS  Google Scholar 

  4. Ivens K, Gradaus F, Heering P et al (2001) Myocardial revascularization in patients with end-stage renal disease: comparison of percutaneous transluminal coronary angioplasty and coronary artery bypass grafting. Int Urol Nephrol 32:717–723

    Article  PubMed  CAS  Google Scholar 

  5. Charytan DM, Kuntz RE (2007) Risks of coronary artery bypass surgery in dialysis-dependent patients–analysis of the 2001 National Inpatient Sample. Nephrol Dial Transpl 22:1665–1671

    Article  Google Scholar 

  6. Herzog CA, Ma JZ, Collins AJ (2002) 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 106:2207–2211

    Article  PubMed  Google Scholar 

  7. Dacey LJ, Liu JY, Braxton JH, Northern New England Cardiovascular Disease Study Group et al (2002) Long-term survival of dialysis patients after coronary bypass grafting. Ann Thorac Surg 74:458–462

    Article  PubMed  Google Scholar 

  8. Liu JY, Birkmeyer NJ, Sanders JH, Northern New England Cardiovascular Disease Study Group et al (2000) Risks of morbidity and mortality in dialysis patients undergoing coronary artery bypass surgery. Circulation 102:2973–2977

    PubMed  CAS  Google Scholar 

  9. Cooper WA, O’Brien SM, Thourani VH et al (2006) Impact of renal dysfunction on outcomes of coronary artery bypass surgery: results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation 113:1063–1070

    Article  PubMed  Google Scholar 

  10. Vittinghoff E, McCulloch CE (2007) Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 165:710–718

    Article  PubMed  Google Scholar 

  11. Hamada Y, Kawachi K, Nakata T (2001) Cardiac surgery in patients with end-stage renal disease. Utility of continuous ambulatory peritoneal dialysis. Jpn J Thorac Cardiovasc Surg 49(2):99–102

    Article  PubMed  CAS  Google Scholar 

  12. Ko W, Kreiger KH, Isom OW (1993) Cardiopulmonary bypass procedures in dialysis patients. Ann Thorac Surg 55:677–684

    Article  PubMed  CAS  Google Scholar 

  13. McNamee PT, Sombolos KI, David TE et al (1986) Coronary artery bypass surgery in peritoneal dialysis patients. Perit Dial Bull 6:128–130

    Google Scholar 

  14. Abraham G, Blake P, David T (1989) Decreased morbidity in peritoneal dialysis patients undergoing coronary artery bypass graft. Perit Dial Int 9:355–356

    PubMed  CAS  Google Scholar 

  15. Senecal L, Cailhier JF, Chartrand-Lefebvre C et al (2002) Peritoneal and pericardial communication after cardiac surgery with delayed clinical manifestations. Perit Dial Int 22:515–518

    PubMed  Google Scholar 

  16. Nather S, Anger H, Koall W et al (1996) Peritoneal leak and chronic pericardial effusion in a CAPD patient. Nephrol Dial Transpl 11:1155–1158

    CAS  Google Scholar 

  17. Haimov M, Glabman D, Dchupak E et al (1974) General surgery in patients on maintenance hemodialysis. Ann Surg 179:863–867

    Article  PubMed  CAS  Google Scholar 

  18. Franga DL, Kratz JM, Crumbley AJ et al (2000) Early and long-term results of coronary artery bypass grafting in dialysis patients. Ann Thorac Surg 70:813–818

    Article  PubMed  CAS  Google Scholar 

  19. Higashiue S, Nishimura Y, Shinbo M et al (2001) Coronary artery bypass grafting in patients with dialysis-dependent renal failure. Artif Organs 25:263–267

    Article  PubMed  CAS  Google Scholar 

  20. Endo M (2001) Coronary Artery Bypass Grafting in Patients on Chronic Hemodialysis in Japan. Artif Organs 25:237–238

    Article  PubMed  CAS  Google Scholar 

  21. Kulier A, Levin J, Moser R, Investigators of the Multicenter Study of Perioperative Ischemia Research Group, Ischemia Research and Education Foundation et al (2007) Impact of pre-operative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation 116:471–479

    Article  PubMed  Google Scholar 

  22. Bechtel JF, Detter C, Fischlein T et al (2008) Cardiac surgery in patients on dialysis: decreased 30-day mortality, unchanged overall survival. Ann Thorac Surg 85:147–153

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Antigone Oreopoulos for her assistance in statistical analysis in this study.

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Nephrology, University Health Network and University of Toronto, Toronto, ON, Canada

    Hui Zhong, Ai Hua Zhang, Wei Fang, Mufazzal Ahmad, Joanne M. Bargman & Dimitrios G. Oreopoulos

  2. Division of Nephrology, West China Hospital, Sichuan University, Chengdu, 610041, China

    Hui Zhong

  3. Department of Surgery, Division of Cardiac Surgery, University Health Network and University of Toronto, Toronto, ON, Canada

    Tirone David

Authors
  1. Hui Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tirone David
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ai Hua Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wei Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mufazzal Ahmad
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joanne M. Bargman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dimitrios G. Oreopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hui Zhong.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhong, H., David, T., Zhang, A.H. et al. Coronary artery bypass grafting in patients on maintenance dialysis: Is peritoneal dialysis a risk factor of operative mortality?. Int Urol Nephrol 41, 653–662 (2009). https://doi.org/10.1007/s11255-008-9507-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-008-9507-8

Keywords

Search

Navigation