title: Implications of Hemodialysis in Patients Undergoing Coronary Artery Bypass Grafting.
abstract: BACKGROUND
  Cardiovascular disease is the leading cause of morbidity and mortality in patients on hemodialysis. To our knowledge, no studies have examined long-term outcomes of hemodialysis patients following coronary artery bypass grafting (CABG) in a predominately rural, low-income, and racially dichotomous population.
  
  
  METHODS
  Long-term survival of hemodialysis patients undergoing non-emergent, isolated CABG was compared with non-hemodialysis patients. Survival probabilities were computed using the Kaplan-Meier product limit method and stratified by hemodialysis. Hazard ratios (HR) and 95% confidence intervals (95%CI) were computed using a Cox regression model.
  
  
  RESULTS
  Hemodialysis patients (n=220) had shorter long-term survival than non-hemodialysis patients (median survival=3.3 versus 14 years, p<0.0001). The survival difference remained statistically significant after adjusting for clinically relevant variables (HR=5.2, 95%CI=4.4-6.2).
  
  
  CONCLUSIONS
  Hemodialysis patients had significantly shorter long-term survival compared with non-hemodialysis patients after CABG. Further research is needed to address the cost and policy implications of our findings, especially among priority populations.
authors.affiliation: Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA ; Center for Health Disparity Research, East Carolina University, USA.
authors.forename: Jimmy T
authors.initials: JT
authors.lastname: Efird
authors.affiliation: Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA.
authors.forename: Wesley T
authors.initials: WT
authors.lastname: O'Neal
authors.affiliation: Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Gouge
authors.affiliation: Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Kindell
authors.affiliation: Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA.
authors.forename: Whitney L
authors.initials: WL
authors.lastname: Kennedy
authors.affiliation: Department of Internal of Medicine, Division of Nephrology and Hypertension. Brody School of Medicine, East Carolina University, Greenville, NC, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Bolin
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
authors.forename: Jason B
authors.initials: JB
authors.lastname: O'Neal
authors.affiliation: Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA.
authors.forename: Curtis A
authors.initials: CA
authors.lastname: Anderson
authors.affiliation: Saint Thomas Heart Hospital, Nashville, TN, USA.
authors.forename: Evelio
authors.initials: E
authors.lastname: Rodriguez
authors.affiliation: Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA.
authors.forename: T Bruce
authors.initials: TB
authors.lastname: Ferguson
authors.affiliation: Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA.
authors.forename: W Randolph
authors.initials: WR
authors.lastname: Chitwood
authors.affiliation: Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA.
authors.forename: Alan P
authors.initials: AP
authors.lastname: Kypson
keywords: CABG; Hemodialysis; Survival