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Coronary artery bypass grafting in dialysis patients: a propensity score-matched analysis
Jingfang Xu1, Yumeng Wang2, Cheng Chen2
1Department of Nephrology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China.
Insights
Patients on dialysis undergoing coronary artery bypass grafting (CABG) face higher complication rates and reduced survival. Risk factors like smoking and diabetes worsen outcomes in this vulnerable group.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Clinical Outcomes Research
Background:
- Patients on dialysis have increased risk for coronary artery disease requiring coronary artery bypass grafting (CABG).
- Prognostic implications of CABG in dialysis-dependent patients are not well understood.
- This study evaluates short- and long-term outcomes of CABG in dialysis patients.
Purpose of the Study:
- To compare postoperative complications and survival rates.
- To identify risk factors for adverse outcomes in dialysis patients undergoing CABG.
Main Methods:
- Retrospective analysis of 55 dialysis-dependent patients and 55 matched non-dialysis patients.
- Comparison of postoperative complications and survival rates.
- Analysis of baseline characteristics and risk factors.
Main Results:
- Dialysis patients had significantly higher postoperative complications (92.7% vs 61.8%).
- Five-year survival rates were lower in dialysis patients (46.2% vs 58.2%).
- Smoking history, diabetes, heart failure, and concomitant surgery increased mortality risk.
Conclusions:
- Coronary artery bypass grafting (CABG) in dialysis-dependent patients is associated with a poorer prognosis.
- Smoking, diabetes, congestive heart failure, and concomitant surgery are independent risk factors for mortality.
Background:
Patients undergoing dialysis treatment have long been recognized as having an elevated risk of developing coronary artery disease necessitating coronary artery bypass grafting (CABG). However, the prognostic implications of CABG in dialysis-dependent patients remain underexplored. This study aimed to comprehensively assess both short- and long-term outcomes in dialysis-dependent patients undergoing CABG.
Methods:
In this retrospective analysis, we meticulously matched 55 dialysis-dependent patients with 55 non-dialysis patients, controlling for baseline characteristics including age, sex, etiology, and date of surgery. All patients underwent CABG treatment at our institution between January 2014 and June 2022. We conducted a comparative analysis of postoperative complications and survival rates between the two groups.
Results:
Our findings revealed that the dialysis-dependent group exhibited a significantly higher incidence of postoperative complications compared to the non-dialysis group (92.7% vs. 61.8%; p < 0.001). Furthermore, the 5-year survival rates were notably diminished among dialysis patients relative to their non-dialysis counterparts (46.2 ± 7.9% vs. 58.2 ± 12.1%, p = 0.045). Consistently, dialysis patients exhibited decreased 5-year cardiac-event-free rates in contrast to non-dialysis patients (31.6 ± 7.6% vs. 58.8 ± 11.3%, p = 0.041). Predictably, several baseline parameters were identified as significant risk factors contributing to adverse outcomes among dialysis patients, including a history of smoking, diabetes mellitus, congestive heart failure upon admission, and the requirement for intraoperative concomitant surgery (p = 0.006, p = 0.043, p = 0.017, p = 0.003, respectively).
Conclusions:
This study underscores the poorer prognosis associated with CABG treatment in dialysis-dependent patients. Notably, baseline factors such as a smoking history, diabetes mellitus, congestive heart failure upon admission, and the need for intraoperative concomitant surgery were all independently linked to increased mortality in this patient population.
