Outcomes of open heart surgery in patients with end-stage renal disease
- Author:
Jung Hwa PARK
1
;
Jeong Hoon LIM
;
Kyung Hee LEE
;
Hee Yeon JUNG
;
Ji Young CHOI
;
Jang Hee CHO
;
Chan Duck KIM
;
Yong Lim KIM
;
Hanna JUNG
;
Gun Jik KIM
;
Sun Hee PARK
Author Information
- Publication Type:Original Article
- Keywords: Cardiovascular disease; Dialysis; Renal insufficiency; Thoracic surgery
- MeSH: Cardiovascular Diseases; Comorbidity; Diabetes Mellitus; Dialysis; Heart; Hospital Mortality; Hospitalization; Humans; Kidney; Kidney Failure, Chronic; Logistic Models; Mortality; Odds Ratio; Renal Insufficiency; Retrospective Studies; Risk Factors; Thoracic Surgery; Ventilators, Mechanical
- From:Kidney Research and Clinical Practice 2019;38(3):399-406
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND: Cardiovascular diseases of chronic dialysis patients are often undertreated because of their higher surgical risk. This study aimed to assess mortality and morbidity after open heart surgery in chronic dialysis patients compared to those with normal renal function and identify risk factors for postoperative outcomes. METHODS: We retrospectively analyzed 2,432 patients who underwent open heart surgery from 2002 to 2017 and collected data from 116 patients (38 patients on dialysis and 78 age-, sex-, and diabetes mellitus status-matched control patients with normal kidney function). We assessed comorbidities, New York Heart Association (NYHA) class, laboratory data, surgical methods, and postoperative outcomes. RESULTS: The dialysis group had more comorbidities, higher NYHA classes, and greater need for urgent surgeries compared to the control group. They exhibited significantly higher postoperative mortality (18.4% vs. 2.6%, P = 0.005) and more overall complications (65.8% vs. 25.6%, P < 0.001). Dialysis itself significantly increased relative risk for in-hospital mortality after adjustment. EuroSCORE II was not as useful as in the general population. Multivariate logistic regression analysis demonstrated that total (adjusted odds ratio [AOR], 10.7; P = 0.029) and in-hospital death risk (AOR, 14.7; P = 0.033), the durations of postoperative hospitalization (AOR, 4.6; P = 0.034), CRRT (AOR 36.8; P = 0.004), and ventilator use (AOR, 7.6; P = 0.022) were significantly increased in the dialysis group. CONCLUSION: The dialysis group exhibited a higher risk for mortality and overcall complications after open heart surgery compared to the patients with normal renal function. Therefore, the benefit of surgical treatment must be balanced against potential risks.
