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. 2025 Sep 16;12(9):356.
doi: 10.3390/jcdd12090356.

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

Ezin Deniz  1 , Tonita Brunkhorst  1 , Florian Helms  1 , Jasmin Hanke  1 , Ali Merzah  1 , Sadeq Ali-Hasan Al-Saegh  1 , Alina Zubarevich  1 , Felix Fleissner  2 , Issam Ismail  1 , Gregor Warnecke  3 , Günes Dogan  1 , Jan Dieter Schmitto  1 , Bastian Schmack  1 , Alexander Weymann  1 , Arjang Ruhparwar  1 , Aron-Frederik Popov  1
Affiliations

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

Ezin Deniz et al. J Cardiovasc Dev Dis. .

Abstract

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.

Keywords: CABG; cardiac surgery; dialysis; paradigm; risk score.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curve: overall survival.
Figure 2
Figure 2
Kaplan–Meier curve: freedom of major adverse cardiac and cerebrovascular events.
Figure 3
Figure 3
Kaplan–Meier curve: survival of dialysis-dependent patients within EuroSCORE II groups.
Figure 4
Figure 4
Kaplan–Meier curve: survival of non-dialysis-dependent patients within EuroSCORE II groups.
Figure 5
Figure 5
Kaplan–Meier curve: elderly patients (age ≥ 70 years) within EuroSCORE II groups.
Figure 6
Figure 6
Kaplan–Meier curve: non-dialysis-dependent patients with venous grafts only vs. at least one arterial graft.
Figure 7
Figure 7
Kaplan–Meier curve: dialysis-dependent patients with venous grafts only vs. at least one arterial graft.
Figure 8
Figure 8
ROC curves for the EuroSCORE II over time. ROC = Receiver Operating Characteristic; AUC = area under the curve; NDD = non-dialysis-dependent; DD = dialysis-dependent.
See this image and copyright information in PMC

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