Cardiac Surgery Outcomes in Patients Receiving Hemodialysis Versus Peritoneal Dialysis

Overview

Journal Kidney Med

Specialty Nephrology

Date 2024 Mar 4

PMID 38435071

Authors

Elias Bassil

Milad Matta

Haytham El Gharably

Serge Harb

Juan Calle

Susana Arrigain

Jesse Schold

Jonathan Taliercio

Ali Mehdi

Georges Nakhoul

Affiliations

Soon will be listed here.

Abstract

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 χ, Fisher exact, Wilcoxon rank sum, and 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 ( = 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) ( = 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).

Citing Articles

Peritoneal Dialysis After Cardiac Surgery: Time for a Change of Heart.

El Shamy O, Perl J, Shen J Kidney Med. 2024; 6(3):100794.

PMID: 38435067 PMC: 10907213. DOI: 10.1016/j.xkme.2024.100794.

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