Cardiac Surgery Outcomes in Patients Receiving Hemodialysis Versus Peritoneal Dialysis
© 2023 The Authors..
Rationale & Objective: We sought to compare outcomes of patients receiving dialysis after cardiothoracic surgery on the basis of dialysis modality (intermittent hemodialysis [HD] vs peritoneal dialysis [PD]).
Study Design: This was a retrospective analysis.
Setting & Participants: In total, 590 patients with kidney failure receiving intermittent HD or PD undergoing coronary artery bypass graft and/or valvular cardiac surgery at Cleveland Clinic were included.
Exposure: The patients received PD versus HD (intermittent or continuous).
Outcomes: Our primary outcomes were in-hospital and 30-day mortality. Secondary outcomes were length of stay, days in the intensive care unit, the number of intraoperative blood transfusions, postsurgical pericardial effusion, and sternal wound infection, and a composite of the following 4 in-hospital events: death, cardiac arrest, effusion, and sternal wound infection.
Analytical Approach: We used χ2, Fisher exact, Wilcoxon rank sum, and t tests, Kaplan-Meier survival, and plots for analysis.
Results: Among the 590 patients undergoing cardiac surgery, 62 (11%) were receiving PD, and 528 (89%) were receiving intermittent HD. Notably, 30-day Kaplan-Meier survival was 95.7% (95% CI: 93.9-97.5) for HD and 98.2% (95% CI: 94.7-100) for PD (P = 0.30). In total, 75 patients receiving HD (14.2%) and 1 patient receiving PD (1.6%) had a composite of 4 in-hospital events (death, cardiac arrest, effusion, and sternal wound infection) (P = 0.005). Out of 62 patients receiving PD, 16 (26%) were converted to HD.
Limitations: Retrospective analyses are prone to residual confounding. We lacked details about nutritional data. Intensive care unit length of stay was used as a surrogate for volume status control. Patients have been followed in a single health care system. The HD cohort outnumbered the PD cohort significantly.
Conclusions: When compared with PD, HD does not appear to improve outcomes of patients with kidney failure undergoing cardiothoracic surgery. Patients receiving PD had a lower incidence of a composite outcome of 4 in-hospital events (death, cardiac arrest, pericardial effusion, and sternal wound infections).
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:6 |
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| Enthalten in: |
Kidney medicine - 6(2024), 3 vom: 27. März, Seite 100774 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bassil, Elias [VerfasserIn] |
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| Links: |
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| Themen: |
Cardiac surgery |
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| Anmerkungen: |
Date Revised 05.03.2024 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1016/j.xkme.2023.100774 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369249429 |
|---|
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| 245 | 1 | 0 | |a Cardiac Surgery Outcomes in Patients Receiving Hemodialysis Versus Peritoneal Dialysis |
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| 500 | |a Date Revised 05.03.2024 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2023 The Authors. | ||
| 520 | |a Rationale & Objective: We sought to compare outcomes of patients receiving dialysis after cardiothoracic surgery on the basis of dialysis modality (intermittent hemodialysis [HD] vs peritoneal dialysis [PD]) | ||
| 520 | |a Study Design: This was a retrospective analysis | ||
| 520 | |a Setting & Participants: In total, 590 patients with kidney failure receiving intermittent HD or PD undergoing coronary artery bypass graft and/or valvular cardiac surgery at Cleveland Clinic were included | ||
| 520 | |a Exposure: The patients received PD versus HD (intermittent or continuous) | ||
| 520 | |a Outcomes: Our primary outcomes were in-hospital and 30-day mortality. Secondary outcomes were length of stay, days in the intensive care unit, the number of intraoperative blood transfusions, postsurgical pericardial effusion, and sternal wound infection, and a composite of the following 4 in-hospital events: death, cardiac arrest, effusion, and sternal wound infection | ||
| 520 | |a Analytical Approach: We used χ2, Fisher exact, Wilcoxon rank sum, and t tests, Kaplan-Meier survival, and plots for analysis | ||
| 520 | |a Results: Among the 590 patients undergoing cardiac surgery, 62 (11%) were receiving PD, and 528 (89%) were receiving intermittent HD. Notably, 30-day Kaplan-Meier survival was 95.7% (95% CI: 93.9-97.5) for HD and 98.2% (95% CI: 94.7-100) for PD (P = 0.30). In total, 75 patients receiving HD (14.2%) and 1 patient receiving PD (1.6%) had a composite of 4 in-hospital events (death, cardiac arrest, effusion, and sternal wound infection) (P = 0.005). Out of 62 patients receiving PD, 16 (26%) were converted to HD | ||
| 520 | |a Limitations: Retrospective analyses are prone to residual confounding. We lacked details about nutritional data. Intensive care unit length of stay was used as a surrogate for volume status control. Patients have been followed in a single health care system. The HD cohort outnumbered the PD cohort significantly | ||
| 520 | |a Conclusions: When compared with PD, HD does not appear to improve outcomes of patients with kidney failure undergoing cardiothoracic surgery. Patients receiving PD had a lower incidence of a composite outcome of 4 in-hospital events (death, cardiac arrest, pericardial effusion, and sternal wound infections) | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a End-stage kidney disease | |
| 650 | 4 | |a cardiac surgery | |
| 650 | 4 | |a hemodialysis | |
| 650 | 4 | |a kidney failure | |
| 650 | 4 | |a peritoneal dialysis | |
| 700 | 1 | |a Matta, Milad |e verfasserin |4 aut | |
| 700 | 1 | |a El Gharably, Haytham |e verfasserin |4 aut | |
| 700 | 1 | |a Harb, Serge |e verfasserin |4 aut | |
| 700 | 1 | |a Calle, Juan |e verfasserin |4 aut | |
| 700 | 1 | |a Arrigain, Susana |e verfasserin |4 aut | |
| 700 | 1 | |a Schold, Jesse |e verfasserin |4 aut | |
| 700 | 1 | |a Taliercio, Jonathan |e verfasserin |4 aut | |
| 700 | 1 | |a Mehdi, Ali |e verfasserin |4 aut | |
| 700 | 1 | |a Nakhoul, Georges |e verfasserin |4 aut | |
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