The futility of pretransplant coronary bypass grafting in asymptomatic patients on peritoneal dialysis.
OBJECTIVE
To evaluate the validity of recommending coronary artery bypass grafting (CABG) in preparation for renal transplantation in asymptomatic peritoneal dialysis (PD) patients with evidence of reversible myocardial ischemia.


METHODS
Retrospective review in a single PD unit.


METHODS
Ten asymptomatic PD patients who underwent CABG to be placed on the transplant list comprised the study group. Ten age-, sex-, and disease-matched PD patients who did not receive CABG were used as a comparison group.


METHODS
Clinical outcome from 1990 to the present.


RESULTS
Only 1 patient in the study group has received a transplant. Seven patients (70%) have died or have been removed from the list because of comorbid illness. Only 2 patients are still on the waiting list.


CONCLUSIONS
As a result of the long waiting time for cadaveric renal transplant and the high risk of interim development of comorbid disease, only a minority of patients come to transplantation. The presence of coronary disease is likely a surrogate for more generalized cardiac and vascular disease in this population. In light of these findings, the policy of prophylactic revascularization in asymptomatic dialysis patients in preparation for renal transplantation needs to be reconsidered.
Rao
S P
SP
Division of Nephrology, The Toronto Hospital and University of Toronto, Ontario, Canada.
Lenkei
S
S
Chu
M
M
Bargman
J M
JM
D016022:Case-Control Studies; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000601:surgery; D017063:Outcome Assessment, Health Care; D010530:Peritoneal Dialysis; D012189:Retrospective Studies; D016019:Survival Analysis; D014850:Waiting Lists