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Long-Term Single-Center Outcomes of Patients With Chronic Renal Dialysis Undergoing Cardiac Surgery
Fanar Mourad1, Natalia Cleve1, Janine Nowak1
1Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany.
Insights
Cardiac surgery for dialysis-dependent chronic renal failure (DD-CRF) patients has high mortality. Age and congestive heart failure predict death, while kidney transplantation improves survival.
Area of Science:
- Cardiology
- Nephrology
- Cardiac Surgery
Background:
- Dialysis-dependent chronic renal failure (DD-CRF) is a growing global health issue.
- DD-CRF patients face elevated cardiovascular risks, including calcification and congestive heart failure (CHF), leading to poor outcomes.
- This study investigates cardiac surgery outcomes in DD-CRF patients at a single institution.
Purpose of the Study:
- To evaluate the outcomes of cardiac surgery in patients with DD-CRF.
- To identify predictors of mortality in this high-risk population.
- To assess the impact of kidney transplantation on long-term survival.
Main Methods:
- Retrospective analysis of 241 DD-CRF patients undergoing cardiac surgery (2000-2017).
- Primary endpoints included major adverse cardiac and cerebrovascular events and long-term survival.
- Cox regression multivariate analysis was used to determine independent predictors of mortality, with 98.3% follow-up completion.
Main Results:
- The cohort (mean age 63 ± 12.2 years, 65.1% male) had high rates of CHF (41.5%) and previous myocardial infarction (30.7%).
- Early outcomes included 10.4% in-hospital mortality, 7.1% low cardiac output syndrome, and 2.1% stroke.
- Overall mortality reached 61% at long-term follow-up, with age ≥60 and CHF as significant mortality predictors, and kidney transplantation as a protective factor.
Conclusions:
- Cardiac surgery in DD-CRF patients is linked to substantial morbidity and mortality.
- Mortality is often non-cardiac related; advanced age and CHF significantly worsen life expectancy.
- Subsequent kidney transplantation demonstrates a positive impact on long-term survival for these patients.
Background:
The prevalence of dialysis-dependent chronic renal failure (DD-CRF) is growing worldwide. Such patients are exposed to a higher cardiovascular risk because of severe calcification and congestive heart failure caused by volume overload, with poor outcomes. This study aimed to evaluate outcomes of patients with DD-CRF who were undergoing cardiac surgery in a single institution (West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany).
Methods:
A retrospective evaluation of 241 consecutive patients who presented with DD-CRF and were undergoing cardiac-surgery between January 2000 and December 2017 was conducted. End points were major adverse cardiac and cerebrovascular events and long-term survival. Additionally, Cox regression multivariate analysis was performed to detect independent predictors of mortality. Follow-up was 98.3% complete through August 2018.
Results:
The mean age of the study cohort was 63 ± 12.2 years, and 65.1% of these patients were male. Congestive heart failure (CHF) was present in 41.5% of patients, 30.7% had a previous myocardial infarction, 9.1% had previous cardiac surgery, and 22.4% needed urgent or emergency surgery. These patients underwent isolated coronary artery bypass grafting (44.8%), isolated procedures other than coronary artery bypass grafting (17.8%), or concomitant procedures (37.3%). Early outcomes reported in-hospital mortality in 10.4%, low cardiac output syndrome in 7.1%, and stroke in 2.1% of patients, respectively. Overall mortality was recorded in 61% of patients at last follow-up. Cox regression multivariate analysis reported age 60 years or older (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.62 to 3.45; P < .001) and CHF (HR, 1.95; 95% CI, 1.37 to 2.78; P < .001) as positive predictors of death and subsequent kidney transplantation (HR, 0.35; 95% CI, 0.20 to 0.59; P < .001) as a negative predictor of death.
Conclusions:
Cardiac surgery in patients with DD-CRF is associated with high morbidity and mortality. Interestingly, overall mortality was mainly not cardiac related, and older patients or those who presented with CHF had the worst life expectancy. However, subsequent kidney transplantation positively affected long-term survival in these patients.
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