The outcome of cardiac surgery in dialysis-dependent patients.
BACKGROUND
Patients on dialysis for end-stage renal failure (ESRF) are undergoing cardiac surgery with increasing frequency. Furthermore, ESRF is known to be an important risk factor for complications of cardiac operations performed with cardiopulmonary bypass.


OBJECTIVE
To evaluate the outcome of dialysis-dependent patients undergoing cardiac surgery at one institution.


METHODS
A retrospective analysis was performed on consecutive patients with ESRF dependent upon maintenance haemodialysis or peritoneal dialysis who underwent cardiac surgery from January 1998 to August 2002.


RESULTS
Thirty-eight patients on dialysis underwent cardiac surgery during this time period (1.5% of total cases). The most common cause for ESRF was diabetic nephropathy (n = 12). Operations performed included isolated coronary artery bypass grafting (CABG, n = 22), CABG and valve surgery (n = 8), and valve surgery alone (n = 6). When allowing for age, sex, surgeon and operative category, the odds ratio for mortality risk of dialysis patients, compared with all others, was 4.9 (95% confidence interval (CI): 1.7-13.9, p = 0.003), and for morbidity risk, was 2.8 (95% CI: 1.4-5.4, p = 0.003).


CONCLUSIONS
Patients on dialysis have an increased morbidity and mortality following cardiac surgery, however we believe ESRF should not be regarded as an absolute contraindication to cardiac surgery or cardiopulmonary bypass.
Zimmet
Adam D
AD
Cardiothoracic Surgery Unit, Monash Medical Centre, Department of Surgery, Level 5, E Block, Monash University, 246 Clayton Road, Clayton, Vic. 3168, Australia.
Almeida
Aubrey
A
Goldstein
Jacob
J
Shardey
Gilbert C
GC
Pick
Adrian W
AW
Lowe
Cassie E
CE
Jolley
Damien J
DJ
Smith
Julian A
JA
D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome