Challenging the Paradigm: Long-Term Outcomes in Dialysis-Dependent Patients Undergoing CABG

Dialysis-dependent (DD) patients undergoing coronary artery bypass grafting (CABG) remain a particularly high-risk population with impaired outcomes despite advances in surgical techniques. In this single-center, retrospective cohort study, 97 DD patients (2010-2015) were compared with 488 non-dialysis-dependent (NDD) controls. The primary endpoint was all-cause mortality; the secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE). Median follow-up was 5.4 ± 2.1 years. DD patients had significantly higher perioperative mortality (10.3% vs. 3.1%, p = 0.002) and markedly reduced overall survival (OS) (40.8% vs. 82.1% at 5 years). Dialysis dependence conferred an 8.4-fold increase in mortality risk and a 2.6-fold increase in MACCE risk. Increasing age, diabetes, and critical preoperative state were independent predictors of an adverse long-term outcome. While arterial grafting improved survival in NDD patients, no comparable benefit was observed in DD patients, possibly due to vascular calcification, limited conduit availability, and reduced graft patency. EuroSCORE II adequately predicted perioperative mortality (AUC = 0.78 in DD patients) but demonstrated poor discriminatory power for long-term survival (AUC = 0.67 at 5 years). These findings highlight the urgent need for dialysis-specific risk models. Despite poor long-term prognosis, DD patients with low-risk EuroSCORE II profiles experienced the most relative benefit from CABG.