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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Off-pump vs. on-pump coronary artery bypass grafting in patients with chronic kidney disease: an updated systematic
Muhammad Ahmed1, Kanwal Majeed2, Hassam Ali2
1Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan. muhammadahmed5515@gmail.com.
Insights
Off-pump coronary artery bypass grafting (CABG) is associated with lower short-term mortality in chronic kidney disease (CKD) patients compared to on-pump CABG. This meta-analysis highlights a significant survival benefit for the off-pump approach in this vulnerable population.
Area of Science:
- Cardiology
- Nephrology
- Surgical Outcomes
Background:
- Cardiovascular disease is the leading cause of mortality in chronic kidney disease (CKD) patients.
- Coronary artery bypass grafting (CABG) outcomes are often poorer in CKD patients.
Purpose of the Study:
- To compare the short-term mortality rates of off-pump CABG (OPCAB) versus on-pump CABG (ONCAB) in patients with CKD.
- To synthesize evidence from existing studies to inform clinical decision-making.
Main Methods:
- A meta-analysis of 25 studies (23 observational, 2 RCTs) involving 234,585 CKD patients (eGFR < 60 mL/min/1.73 m²).
- Comparison of mortality rates between OPCAB and ONCAB groups.
- Random-effects model used for synthesizing risk ratios (RR) and mean differences (MD).
Main Results:
- On-pump CABG was associated with a significantly higher mortality rate compared to off-pump CABG.
- The risk ratio for mortality in the ONCAB group was 0.73 (95% CI [0.61, 0.88]), P = 0.0006.
- Significant heterogeneity was observed (I² = 60%).
Conclusions:
- Short-term mortality is significantly higher in patients undergoing on-pump CABG compared to off-pump CABG.
- Off-pump CABG appears to be a safer option for CKD patients requiring coronary artery bypass surgery.
Background:
In patients with chronic kidney disease (CKD), cardiovascular disease is found to be the primary cause of mortality, and after coronary artery bypass grafting (CABG), their prognosis deteriorates.
Methods:
We conducted a meta-analysis comparing off-pump CABG versus on-pump CABG in CKD patients. We searched electronic databases, including PubMed, Cochrane, and Google Scholar, using relevant keywords. We included studies comparing off-pump CABG with on-pump CABG in patients with chronic kidney disease, which was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min per 1.73 m2. Effect estimates were synthesized using a random-effects model and expressed as risk ratios (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with corresponding 95% confidence intervals (CIs). Our primary outcome was short-term mortality.
Results:
A total of 25 studies, of which 23 were observational and 2 were RCTs, were included in this meta-analysis, comprising 234,585 patients (66,591 in the off-pump group and 167,994 in the on-pump group). Our meta-analysis showed that there was a significantly higher mortality rate in the on-pump CABG group as compared to the off-pump CABG group (RR: 0.73, 95% CI [0.61, 0.88]; P = 0.0006, I2 = 60%).
Conclusion:
Compared with OPCAB, short-term mortality was significantly higher in ONCAB.
