Long-Term Single-Center Outcomes of Patients With Chronic Renal Dialysis Undergoing Cardiac Surgery

Abstract

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.