Cardiac Surgery Outcomes in Patients Receiving Hemodialysis Versus Peritoneal Dialysis

Abstract

Rationale & ObjectiveWe sought to compare outcomes of dialysis patients post cardiothoracic surgery based on dialysis modality (intermittent hemodialysis (HD) vs peritoneal dialysis (PD)). Study DesignRetrospective Analysis Setting & Participants590 patients with kidney failure receiving intermittent HD or PD undergoing Coronary Artery Bypass Graft (CABG) and/or valvular cardiac surgery at Cleveland Clinic. ExposurePeritoneal Dialysis versus Hemodialysis (Intermittent or Continuous) OutcomesOur primary outcomes were in-hospital and 30-day mortality. Secondary outcomes were length of stay (LOS), days in the ICU, number of intra-operative blood transfusions, post-surgical pericardial effusion, and sternal wound infection, and the composite of 4 in-hospital events: death, cardiac arrest, effusion, and sternal wound infection. Analytical ApproachChi-square, Fisher’s exact, Wilcoxon rank-sum, and t-tests, Kaplan-Meier survival, and plots. ResultsAmong 590 patients undergoing cardiac surgery, 62 (11%) were receiving PD, and 528 (89%) were receiving intermittent HD. 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). 75 (14.2%) HD and 1 (1.6%) PD had composite of 4 in-hospital events (death, cardiac arrest, effusion, and sternal wound infection) (P=0.005). Out of 62 PD patients, 16 (26%) were converted to HD. LimitationsRetrospective analyses are prone to residual confounding. We lacked details about nutritional data. ICU 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 outnumbers the PD cohort significantly. ConclusionsWhen compared to 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).