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Impact of Chronic Kidney Disease and Dialysis on Outcome after Surgery for Infective Endocarditis

Ahmed Elderia1, Ellen Kiehn1, Ilija Djordjevic1

  • 1Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50937 Köln, Germany.

Journal of Clinical Medicine
|September 28, 2023
PubMed

Insights

Outcomes for surgically treated infective endocarditis (IE) worsen with chronic kidney disease (CKD) severity. Hemodialysis (HD) patients face significantly higher mortality, with Staphylococcus aureus being a key risk factor.

Area of Science:

  • Cardiology
  • Nephrology
  • Infectious Diseases

Background:

  • Infective endocarditis (IE) presents a significant challenge in patients with chronic kidney disease (CKD), particularly those on hemodialysis (HD).
  • Understanding risk factors and outcomes in this vulnerable population is crucial for improving patient management.

Purpose of the Study:

  • To investigate the risk factors, clinical profile, and outcomes of surgically treated IE in patients with CKD and HD.
  • To compare outcomes between HD and non-HD patients undergoing IE surgery.
  • To analyze the impact of CKD stage on IE surgical outcomes.

Main Methods:

  • Retrospective analysis of 534 non-HD and 58 HD patients who underwent surgery for IE between 2009 and 2018.
  • Preoperative stratification of patients into HD and non-HD groups.
  • Further subgroup analysis based on CKD stage.

Main Results:

  • HD patients had a higher median EuroSCORE II (9.5 vs. 8.0, p=0.004).
  • 30-day and 1-year mortality rates were substantially higher in HD patients (38.1% and 75.6%) compared to non-HD patients (5.6% and 15.5%).
  • Staphylococcus aureus IE was more frequent in the HD group (p=0.006), and both CKD and S. aureus were independent risk factors for 1-year mortality.

Conclusions:

  • Surgical outcomes for IE are inversely correlated with CKD severity, with the poorest outcomes observed in HD patients.
  • Pre-existing CKD and Staphylococcus aureus infection are independent predictors of increased 1-year mortality after IE surgery.
  • This highlights the critical need for tailored management strategies for IE in CKD and HD populations.

Keywords:
chronic kidney diseasechronic renal failuredialysisinfective endocarditisrenal insufficiencyvalve surgery

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