Coronary artery bypass grafting in patients on chronic hemodialysis: diabetic nephropathy versus nondiabetic nephropathy

Patients with both end-stage renal disease and diabetes mellitus carry an increased risk of coronary atherosclerosis. This study was performed to evaluate the perioperative and remote outcome of diabetic nephropathy patients on hemodialysis undergoing coronary artery bypass grafting (CABG). We retrospectively analyzed the results of CABG performed between September 1, 1993 and August 31, 2001. Preoperative, perioperative, and follow-up data of patients with hemodialysis primarily due to diabetic nephropathy (Group D, n = 31, 22 males and 9 females with a mean age of 60.1 +/- 6.6) were collected and compared to patients with hemodialysis primarily due to nondiabetic nephropathy (group N, n = 21, 17 males and 4 females with a mean age of 60.9 +/- 11.2). Preoperative risk factors between the 2 groups were not significantly different. The mean number of distal anastomoses was 2.5 +/- 1.2 in Group D and 2.5 +/- 1.0 in Group N (p = not significant [NS]). All patients received at least 1 internal mammary artery graft. There was 1 in-hospital death in each group. Postoperative recovery, mortality, and morbidity were not significantly different between the two groups. At the mean follow-up of 2.7 years, the actuarial 3 year survival rate was 72.8% in Group D and 78.7% in Group N (p = NS). The actuarial 3 year cardiac event-free rate was 79.7% in Group D and 74.7% in Group N (p = NS). CABG for hemodialysis patients can be performed with acceptable risks. Diabetic nephropathy has no impact on early or remote patient outcomes among patients on hemodialysis.