Particularities of cardiac surgery in chronic hemodialysis patients

Cardiovascular disease is the most common cause of death in chronic hemodialysis patients(1). Cardiac surgery in hemodialysis patients exposes to higher risks inherent in the particular status of these patients. The aim of our study is to report the perioperative particularities of hemodialysis patients undergoing cardiac surgery, and to determine the impact of preoperative clinical status on hospital and late morbidity and mortality.

Between January 1998 and December 2012, 48 patients in chronic hemodialysis (HD) and candidates for cardiac surgery on cardiopulmonary bypass were retrospectively included.

The mean age was 56 years. Causes of renal insufficiency were dominated by diabetes (n = 20; 42%) and nephroangiosclerosis (n= 9, 18.8%). The duration of HD was 48.22 ± 44.5 months (1 month -11 years). Surgical procedures included coronary artery bypass grafting CABG (n = 33, 68.75%), Valvular replacement (n = 13, 27%) and combined surgery (n = 2, 4.25%). Nine patients (18.8%) underwent emergency surgery. The mean Euroscore I was 8.82 ± 7.76. Hospital mortality was 20.8%. Postoperative complications were observed in 87.5%patients. Age, diabetic nephropathy, Duration of hemodialysis greater than 54 months, preoperative hemoglobin <9 g / dl, combined surgery and emergency surgery were independent predictors of hospital mortality with odds ratio respectively 1.21; 2.7; 2.54; 1.83; 2.54 and 2.85. The survival rates at 1, 4 and 7 years were respectively 75, 65 and 50%.

Age, diabetic nephropathy, Duration of hemodialysis greater than 54 months, preoperative hemoglobin <9 g / dl, combined surgery and emergency surgery are predictive factors for hospital mortality. Early diagnosis of coronary and valvular damage and preoperative preparation considering these factors could improve the prognosis.