Journal of Vascular and Endovascular Therapy

Abstract

Background

End-stage renal disease (ESRD) has been shown to be associated with increased mortality in patients undergoing cardiac surgery. We aimed to compare the short-and mid-term mortality after cardiac surgery of patients with dialysis- dependent ESRD (DD-ESRD) to patients with normal renal function (NRF), using national registries: the ESRD registry, the Adult Cardiac Surgery Registry (ACSR) and the National Mortality Registry.

Methods

The study population comprised 8514 adult patients who underwent either isolated Coronary Artery Bypass Grafting (CABG), isolated Aortic valve replacement/repair (AVR/Avr), isolated Mitral valve replacement/repair (MVR/ MVr), or CABG + valve related procedure, between January 2017 and April 2019. Data were retrospectively extracted and reported to the ACSR by the department of medical records of each medical center.

Results

One hundred and four DD-ESRD patients (mean age 63.2±8.8 years, 83.7% males) were compared with 8410 NRF patients (mean age 64.5±10.2 years, 77.2% males). Median follow-up for the total cohort was of 32.0 months (IQR; 25.0- 40.0). In DD-ESRD compared to NRF patients, 30-day mortality was higher (14.4% vs. 2.2%, respectively, p=0.0001) and four-year survival was significantly lower (43%±5.0 vs. 91%±4.0, respectively, p=0.0001). Fifty three percent of DD-ESRD 30- day mortality was caused by sepsis. Risk factors associated with reduced mid-term survival included: DD-ESRD patients (HR=4.7, 95%CI; 1.3-18.2), MVR procedure (HR=1.5, 95%CI; 1.04-2.1) and combined CABG + valve related procedure (HR=1.6, 95%CI; 1.2-2.03).

Conclusions

Preoperative DD-ESRD was associated with a significant increase in 30-day and mid-term mortality after cardiac surgery. The highest mortality rate was observed in valvular and combined procedures.