1
|
Lin CH, Chen YY, Yen YT, Kao PHJ, Chua CH, Chao HH, Lu MJ. Short-term and long-term outcomes of on-pump beating-heart coronary artery bypass surgery in dialysis and non-dialysis patients: a retrospective study in a single center. J Cardiothorac Surg 2024; 19:268. [PMID: 38689317 PMCID: PMC11059615 DOI: 10.1186/s13019-024-02662-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 03/20/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the short-term and long-term outcomes of dialysis and non-dialysis patients after On-pump beating-heart coronary artery bypass grafting (OPBH-CABG). METHODS We retrospectively reviewed medical records of 659 patients underwent OPBH-CABG at our hospital from 2009 to 2019, including 549 non-dialysis patients and 110 dialysis patients. Outcomes were in-hospital mortality, length of stay, surgical complications, post-CABG reintervention, and late mortality. The median follow-up was 3.88 years in non-dialysis patients and 2.24 years in dialysis patients. Propensity matching analysis was performed. RESULTS After 1:1 matching, dialysis patients had significantly longer length of stay (14 (11-18) vs. 12 (10-15), p = 0.016), higher rates of myocardial infarction (16.85% vs. 6.74%, p = 0.037) and late mortality (25.93% vs. 9.4%, p = 0.005) after CABG compared to non-dialysis patients. No significant differences were observed in in-hospital mortality, complications, or post-CABG reintervention rate between dialysis and non-dialysis groups. CONCLUSIONS OPBH-CABG could achieve comparable surgical mortality, surgical complication rates, and long-term revascularization in dialysis patients as those in non-dialysis patients. The results show that OPBH-CABG is a safe and effective surgical option for dialysis patients.
Collapse
Affiliation(s)
- Chia-Hsun Lin
- Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wenchang Road, Shihlin District, Taipei City, 111045, Taiwan
- School of Medicine, Fu-Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City, 242062, Taiwan
| | - Yen-Yang Chen
- Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wenchang Road, Shihlin District, Taipei City, 111045, Taiwan
| | - Yu-Tong Yen
- Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wenchang Road, Shihlin District, Taipei City, 111045, Taiwan
| | - Patrick Hung-Ju Kao
- Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wenchang Road, Shihlin District, Taipei City, 111045, Taiwan
| | - Chai-Hock Chua
- Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wenchang Road, Shihlin District, Taipei City, 111045, Taiwan
| | - Hung-Hsing Chao
- Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wenchang Road, Shihlin District, Taipei City, 111045, Taiwan
| | - Ming-Jen Lu
- Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wenchang Road, Shihlin District, Taipei City, 111045, Taiwan.
- School of Medicine, Fu-Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City, 242062, Taiwan.
| |
Collapse
|
2
|
Surgical Outcomes and Fusion Rate Following Spinal Fusion in Patients with Chronic Kidney Disease: Impact of Kidney Function. World Neurosurg 2022; 168:e587-e594. [DOI: 10.1016/j.wneu.2022.09.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/15/2022] [Indexed: 11/20/2022]
|
3
|
Dokollari A, Sicouri S, Ramlawi B, Veshti A, Torregrossa G. Coronary artery bypass or percutaneous coronary intervention in dialysis-dependent patients: An unresolved dilemma. J Card Surg 2022; 37:3374-3375. [PMID: 35900306 DOI: 10.1111/jocs.16803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Aleksander Dokollari
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Serge Sicouri
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Basel Ramlawi
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA.,Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Altin Veshti
- Department of Cardiac Surgery, Mother Teresa Hospital, Medical University of Tirana, Tirana, Albania
| | - Gianluca Torregrossa
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA.,Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA
| |
Collapse
|
4
|
Surgical outcomes of acute type A aortic dissection in dialysis patients: lessons learned from a single-center’s experience. Sci Rep 2022; 12:5372. [PMID: 35354894 PMCID: PMC8967816 DOI: 10.1038/s41598-022-09448-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/23/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractThere is a paucity of data describing the safety and efficacy of acute type A aortic dissection (ATAAD) repair surgeries in dialysis patients. Our study aimed to investigated the influence of dialysis on early and late outcomes in end-stage renal disease (ESRD) patients who received repair surgery for ATAAD. A total of 882 ATAAD patients who received emergency aortic dissection repair at our center from January 2015 to December 2019 were retrospectively screened in this study and divided into the dialysis group (n = 16) and the non-dialysis group (n = 866), depending on whether they required dialysis for preoperative ESRD. No significant difference of age, preoperative hemodynamics, organ ischemia conditions, operative variables as well as the 30-Day mortality and in-hospital complications was discovered between two groups. However, the survival rates and the proportion of late aortic event (sudden death and reoperation) free population at 1 and 3 years after surgery were significantly decreased in dialysis patients compared to non-dialysis patients. Our study indicated that the short-term surgical outcomes of ATAAD in dialysis patients were comparable to non-dialysis patient. However, the dialysis patients were associated with a worse long-term prognosis.
Collapse
|
5
|
Palamuthusingam D, Nadarajah A, Johnson DW, Pascoe EM, Hawley CM, Fahim M. Morbidity after elective surgery in patients on chronic dialysis: a systematic review and meta-analysis. BMC Nephrol 2021; 22:97. [PMID: 33736605 PMCID: PMC7977605 DOI: 10.1186/s12882-021-02279-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/22/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Patients on chronic dialysis are at increased risk of postoperative mortality following elective surgery compared to patients with normal kidney function, but morbidity outcomes are less often reported. This study ascertains the excess odds of postoperative cardiovascular and infection related morbidity outcomes for patients on chronic dialysis. METHODS Systematic searches were performed using MEDLINE, Embase and the Cochrane Library to identify relevant studies published from inception to January 2020. Eligible studies reported postoperative morbidity outcomes in chronic dialysis and non-dialysis patients undergoing major non-transplant surgery. Risk of bias was assessed using the Newcastle-Ottawa Scale and the certainty of evidence was summarised using GRADE. Random effects meta-analyses were performed to derive summary odds estimates. Meta-regression and sensitivity analyses were performed to explore heterogeneity. RESULTS Forty-nine studies involving 10,513,934 patients with normal kidney function and 43,092 patients receiving chronic dialysis were included. Patients on chronic dialysis had increased unadjusted odds of postoperative cardiovascular and infectious complications within each surgical discipline. However, the excess odds of cardiovascular complications was attenuated when odds ratios were adjusted for age and comorbidities; myocardial infarction (general surgery, OR 1.83 95% 1.29-2.36) and stroke (general surgery, OR 0.95, 95%CI 0.84-1.06). The excess odds of infectious complications remained substantially higher for patients on chronic dialysis, particularly sepsis (general surgery, OR 2.42, 95%CI 2.12-2.72). CONCLUSION Patients on chronic dialysis are at increased odds of both cardiovascular and infectious complications following elective surgery, with the excess odds of cardiovascular complications attributable to being on dialysis being highest among younger patients without comorbidities. However, further research is needed to better inform perioperative risk assessment.
Collapse
Affiliation(s)
- Dharmenaan Palamuthusingam
- Metro South Integrated Nephrology and Transplant Services, Logan Hospital, Armstrong Road & Loganlea Road, Meadowbrook, Queensland, 4131, Australia.
- Faculty of Medicine, University of Queensland, Armstrong Road & Loganlea Road, St Lucia, Queensland, 4072, Australia.
- School of Medicine, Griffith University, 68 University Dr, Meadowbrook, QLD, 4131, Australia.
| | - Arun Nadarajah
- Department of Surgery, Sunshine Coast University Hospital, Doherty St, Birtinya, Queensland, 4575, Australia
| | - David Wayne Johnson
- Faculty of Medicine, University of Queensland, Armstrong Road & Loganlea Road, St Lucia, Queensland, 4072, Australia
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4074, Australia
- Translational Research Institute, Brisbane, Australia
| | - Elaine Marie Pascoe
- Centre for Health Services Research, University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Carmel Marie Hawley
- Faculty of Medicine, University of Queensland, Armstrong Road & Loganlea Road, St Lucia, Queensland, 4072, Australia
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4074, Australia
- Centre for Health Services Research, University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Magid Fahim
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4074, Australia
- Centre for Health Services Research, University of Queensland, St Lucia, Queensland, 4072, Australia
| |
Collapse
|
6
|
Page S, Yong MS, Saxena P, Yadav S. Outcomes in Dialysis-Dependent Indigenous and Non-Indigenous Patients Undergoing Cardiac Surgery at Townsville University Hospital. Heart Lung Circ 2021; 30:1200-1206. [PMID: 33744195 DOI: 10.1016/j.hlc.2021.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/09/2021] [Accepted: 02/10/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Dialysis-dependent patients have a high risk of cardiovascular death but also a high risk for perioperative mortality in cardiac surgery. Our study examined surgical complications and mortality in Indigenous and non-Indigenous dialysis-dependent patients undergoing cardiac surgery at a single centre. METHODOLOGY The retrospective study reviewed 72 consecutive dialysis-dependent patients who underwent cardiac surgery between 2008 and 2018. Data was prospectively collected, and follow-up was obtained from physicians and general practitioners. Multivariable analysis was performed to determine predictors of mortality. RESULTS The median age of Indigenous Australian patients was 60 years, compared with 65 years for non-Indigenous patients. Indigenous Australian patients had a significantly higher rate of return to theatre (43% versus 17%). The predominant reason for return to theatre for the whole cohort was postoperative bleeding (n=16, 22%). The overall early mortality rate was 10%. There were 35 late deaths (49%) and overall survival at 5 years was 40.92±6.8% (95% CI: 28-54%). History of arrhythmia (p=0.019) was a significant risk factor for mortality, whilst patients who underwent isolated coronary artery bypass grafting (p=0.004), and those who received internal mammary artery grafts (p=0.021) had a reduced hazard ratio for mortality. The median follow-up time was 29 months (IQR 10-52 mo). CONCLUSION Dialysis-dependent Indigenous Australian patients present younger for cardiac surgery, with a higher prevalence of co-morbid diabetes and more extensive coronary artery disease. There was no statistically significant difference in early or late mortality between Indigenous and non-Indigenous patients. However, there was a higher rate of return to theatre amongst the Indigenous Australian cohort.
Collapse
Affiliation(s)
- Sarah Page
- Department of Cardiothoracic Surgery, Townsville University Hospital, Townsville, Qld, Australia.
| | - Matthew S Yong
- Department of Cardiothoracic Surgery, Townsville University Hospital, Townsville, Qld, Australia
| | - Pankaj Saxena
- Department of Cardiothoracic Surgery, Townsville University Hospital, Townsville, Qld, Australia; James Cook University, Townsville, Qld, Australia
| | - Sumit Yadav
- Department of Cardiothoracic Surgery, Townsville University Hospital, Townsville, Qld, Australia; James Cook University, Townsville, Qld, Australia
| |
Collapse
|
7
|
Liao KM, Kuo LT, Lu HY. Hospital costs and prognosis in end-stage renal disease patients receiving coronary artery bypass grafting. BMC Nephrol 2020; 21:333. [PMID: 32770957 PMCID: PMC7414285 DOI: 10.1186/s12882-020-01972-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 07/21/2020] [Indexed: 02/02/2023] Open
Abstract
Background Coronary artery disease is common in patients with end-stage renal disease (ESRD). Patients with ESRD are a high-risk group for cardiac surgery and have increased morbidity and mortality. Most studies comparing ESRD patients receiving coronary artery bypass grafting (CABG) or percutaneous coronary intervention have found that the long-term survival is good in ESRD patients after CABG. The aim of our study was to compare ESRD patients who underwent CABG with the general population who underwent CABG, in terms of prognosis and hospital costs. Methods This study analyzed data from the National Health Insurance Research Database in Taiwan for patients who were diagnosed with ESRD and received CABG (ICD-9-CM codes 585 or 586) between January 1, 2004, and December 31, 2009. The ESRD patients included in this study all received catastrophic illness cards with the major illness listed as ESRD from the Ministry of Health and Welfare in Taiwan. The control subjects were randomly selected patients without ESRD after propensity score matching with ESRD patients according to age, gender, and comorbidities at a 2:1 ratio from the same dataset. Results A total of 48 ESRD patients received CABG, and their mean age was 62.04 ± 10.04 years. Of these patients, 29.2% were aged ≥70 years, and 66.7% were male. ESRD patients had marginally higher intensive care unit (ICU) stays (11.06 vs 7.24 days) and significantly higher ICU costs (28,750 vs 17,990 New Taiwan Dollars (NTD)) than non-ESRD patients. Similarly, ESRD patients had significantly higher surgical costs (565,200 vs. 421,890 NTD), a higher perioperative mortality proportion (10.4% vs 2.1%) and a higher postoperative mortality proportion (33.3% vs 11.5%) than non-ESRD patients. Conclusions After CABG, ESRD patients had a higher risk of mortality than non-ESRD patients, and ICU and surgery costs were also higher among the ESRD patients than among patients without ESRD.
Collapse
Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan
| | - Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin, Taiwan.
| |
Collapse
|
8
|
Palamuthusingam D, Nadarajah A, Pascoe EM, Craig J, Johnson DW, Hawley CM, Fahim M. Postoperative mortality in patients on chronic dialysis following elective surgery: A systematic review and meta-analysis. PLoS One 2020; 15:e0234402. [PMID: 32589638 PMCID: PMC7319352 DOI: 10.1371/journal.pone.0234402] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/24/2020] [Indexed: 01/11/2023] Open
Abstract
RATIONALE & OBJECTIVE The prognostic significance of dialysis-dependent end-stage kidney disease on postoperative mortality is unclear. This study aims to estimate the odds of postoperative mortality in patients receiving chronic dialysis undergoing elective surgery compared to patients with normal kidney function, and to examine the influence of comorbidities on the excess mortality risk. METHODS A systematic search of studies published up to January 2020 was conducted using MEDLINE, EMBASE and CENTRAL databases. Eligible studies reported postoperative 30-day or in-hospital mortality in chronic dialysis patients compared to patients with normal kidney function undergoing elective surgery. Two investigators independently reviewed all abstracts and performed risk of bias assessments using the Newcastle-Ottawa Scale. Quality of evidence was summarised in accordance with GRADE methodology (grading of recommendations, assessment, development and evaluation). Relative mortality risk estimates were obtained using random effects meta-analysis. Heterogeneity was explored using meta-regression. (PROSPERO CRD42017076565). RESULTS Forty-nine studies involving 41, 822 chronic dialysis and 10, 476, 321 non-dialysis patients undergoing elective surgery were included. Patients on chronic dialysis had a greatly increased postoperative mortality odds compared to patients with normal kidney function. The excess risk ranged from OR 10.8 (95%CI 7.3-15.9) following orthopaedic surgery to OR 4.0 (95%CI 3.2-4.9) after vascular surgery. Adjustment for age and comorbidity attenuated the excess odds but remained higher for patients on chronic dialysis, irrespective of surgical discipline. Meta-regression analysis demonstrated an inverse linear relationship between excess mortality risk and study-level mean age (slope -0.06; P = 0.001) and diabetes prevalence (slope -0.02; p = 0.001). CONCLUSIONS Patients on chronic dialysis have an increased odds for postoperative mortality following elective surgery across all surgical disciplines. This relationship is consistent among all studies, with the excess postoperative mortality attributable to end-stage kidney disease and chronic dialysis treatment may be lower among older patients with diabetes.
Collapse
Affiliation(s)
- Dharmenaan Palamuthusingam
- Metro South and Integrated Nephrology and Transplant Services, Logan Hospital, Meadowbrook, Queensland, Australia
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
- School of Medicine, Griffith University, Mount Gravatt, Queensland, Australia
| | - Arun Nadarajah
- Department of Surgery, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Elaine M. Pascoe
- Centre for Health Services Research, University of Queensland, St Lucia, Queensland, Australia
| | - Jonathan Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - David W. Johnson
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Carmel M. Hawley
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Magid Fahim
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Metro North Hospital and Health Service, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
| |
Collapse
|
9
|
Ezaka M, Tsukamoto J, Matsuo K, Kin N, Yamaoka K. Hyperlactatemia of dialysis-dependent patients after cardiac surgery impacts on in-hospital mortality: a two-center retrospective study. JA Clin Rep 2020; 6:47. [PMID: 32529341 PMCID: PMC7290016 DOI: 10.1186/s40981-020-00348-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Lactate is a well-known marker to estimate prognosis after cardiac surgery and critically ill patients. The liver and kidney have a major role in lactate metabolism; however, there was less characterized about the change of lactate and threshold to predict in-hospital mortality in dialysis-dependent patients undertaking cardiac surgery. We conducted this retrospective observational study to characterize when and how lactate values after cardiac surgery affected in-hospital mortality. Methods This two-center retrospective study included dialysis-dependent patients who underwent cardiac surgery with a cardiopulmonary bypass from January 2014 to December 2018. Lactate values were collected at three points: at ICU admission (T1), the maximum level of lactate within 24 h postoperatively (T2), and 24 h after ICU admission (T3). We determined hyperlactatemia as more than 2 mmol/L following previous studies. Results We enrolled 122 dialysis-dependent patients. The mean age was 73 ± 8 years and hyperlactatemia was observed in 100 patients (81.9%). In-hospital mortality was 11.4%. Univariate analysis and area under curve in ROC suggested that T2 lactate was the most significantly associated with in-hospital mortality (AUC = 0.845). Multivariate logistic analysis showed a significant association between in-hospital mortality when patients showed early peak lactate levels of > 4.5 mmol/L after ICU admission (adjusted OR 8.35; 95% CI: 1.44–57.13). Conclusions In dialysis-dependent patients after cardiac surgery, the early-onset of a maximum arterial lactate concentration of > 4.5 mmol/L was significantly associated with in-hospital mortality.
Collapse
Affiliation(s)
- Mariko Ezaka
- Department of Anesthesiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan. .,Teikyo University Graduate School of Public Health, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Junko Tsukamoto
- Department of Anesthesiology, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - Koichi Matsuo
- Department of Intensive Care Unit, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Nobuhide Kin
- Department of Anesthesiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Kazue Yamaoka
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8605, Japan
| |
Collapse
|
10
|
Palamuthusingam D, Johnson DW, Hawley CM, Pascoe E, Sivalingam P, Fahim M. Perioperative outcomes and risk assessment in dialysis patients: current knowledge and future directions. Intern Med J 2020; 49:702-710. [PMID: 30485661 DOI: 10.1111/imj.14168] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/07/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
Abstract
Perioperative medicine is rapidly emerging as a key discipline to address the specific needs of high-risk surgical groups, such as those on chronic dialysis. Crude hospital separation rates for chronic dialysis patients are considerably higher than patients with normal renal function, with up to 15% of admission being related to surgical intervention. Dialysis dependency carries substantial mortality and morbidity risk compared to patients with normal renal function. This group of patients has a high comorbid burden and complex medical need, making accurate perioperative planning essential. Existing perioperative risk assessment tools are unvalidated in chronic dialysis patients. Furthermore, they fail to incorporate important dialysis treatment-related characteristics that could potentially influence perioperative outcomes. There is a dearth of information on perioperative outcomes of Australasian dialysis patients. Current perioperative outcome estimates stem predominantly from North American literature; however, the generalisability of these findings is limited, as the survival of North American dialysis patients is significantly inferior to their Australasian counterparts and potentially confounds reported perioperative outcomes; let alone regional variation in surgical indication and technique. We propose that data linkage between high-quality national registries will provide more complete data with more detailed patient and procedural information to allow for more informative analyses to develop and validate dialysis-specific risk assessment tools.
Collapse
Affiliation(s)
- Dharmenaan Palamuthusingam
- Department of Nephrology, Princess Alexandra Hospital, Metro South and Ipswich Nephrology and Transplant Services (MINTS), Queensland, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Metro South and Ipswich Nephrology and Transplant Services (MINTS), Queensland, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Metro South and Ipswich Nephrology and Transplant Services (MINTS), Queensland, Australia
| | | | - Pal Sivalingam
- Department of Anaesthetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Magid Fahim
- Department of Nephrology, Princess Alexandra Hospital, Metro South and Ipswich Nephrology and Transplant Services (MINTS), Queensland, Australia
| |
Collapse
|
11
|
Khan MR, Khan H, Wahab A, Chaudhary S, Munir A, Youssef J, Mocanu M, Ríos-Bedoya CF, Changezi H, Kesari K. Effect of glycemic control on mortality and infections in patients undergoing coronary artery bypass grafting: a Genesee County experience. J Community Hosp Intern Med Perspect 2019; 9:74-79. [PMID: 31044035 PMCID: PMC6484482 DOI: 10.1080/20009666.2019.1581044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/05/2019] [Indexed: 01/04/2023] Open
Abstract
Background: We report post-coronary artery bypass outcomes and factors affecting the outcomes from the Genesee County, MI, where the population is distinctly characterized by a higher prevalence of renal failure (RF), diabetes, obesity and smoking than the national average. Methods: We performed a retrospective cohort study on 1133 patients undergoing isolated CABG at our hospital from June 2012 to July 2017. Primary outcome was the association between preoperative hemoglobin A1c (HbA1c) and all-cause postoperative mortality after CABG, secondary outcomes included the association between HbA1c and a composite of postoperative infections including sternal-wound infections, leg harvest-site infections, pneumonia or sepsis. Logistic Regression analyses were also performed. Results: There was no difference in the mortality rate (OR 1.0, 95% CI 0.4-2.3) and composite of all infections (OR 1.0, 95% CI 0.7-1.6) between the controlled (HbA1c ≤7%) and uncontrolled (HbA1c >7%) groups. However, RF (OR 5.9, 95% CI 1.5-22.9), smoking (OR 3.7, 95% CI 1.3-11.2) and ejection fraction <35% (OR 3.4, 95% CI 1.4-8.3) were independently associated with increased mortality after CABG. Additionally, low EF (OR 2.4, 95% CI 1.4-4.1) and smoking (OR 2.3, 95% CI 1.2-4.1) were associated with an increased rate of composite of all infections after CABG. Conclusion: Although not different in controlled and uncontrolled diabetic groups, mortality, in our population was associated with comorbidities like RF, smoking and congestive heart failure that are highly prevalent, emphasizing the need for interventions at primary care level to improve the postoperative outcomes after CABG.
Collapse
Affiliation(s)
- Mahin R Khan
- Department of Internal Medicine, McLaren-Flint/Michigan State University, Flint, MI, USA
| | - Hafiz Khan
- Department of Internal Medicine, McLaren-Flint/Michigan State University, Flint, MI, USA
| | - Ahsan Wahab
- Department of Internal Medicine, McLaren-Flint/Michigan State University, Flint, MI, USA
| | - Siddique Chaudhary
- Department of Internal Medicine, McLaren-Flint/Michigan State University, Flint, MI, USA
| | - Ahmad Munir
- Division of Cardiology, Department of Internal Medicine, McLaren-Flint, Flint, MI, USA
| | - John Youssef
- Department of Scholarly Activity, McLaren Health Care, Flint, MI, USA
| | - Marian Mocanu
- Division of Cardiology, Department of Internal Medicine, McLaren-Flint, Flint, MI, USA
| | - Carlos F Ríos-Bedoya
- Division of Pulmonary and Critical Care, Department of Internal Medicine, McLaren-Flint, Flint, MI, USA
| | - Hameem Changezi
- Division of Cardiology, Department of Internal Medicine, McLaren-Flint, Flint, MI, USA
| | - Kavitha Kesari
- Department of Internal Medicine, McLaren-Flint/Michigan State University, Flint, MI, USA
| |
Collapse
|
12
|
Bianco V, Kilic A, Gleason TG, Aranda‐Michel E, Navid F, Sultan I. Longitudinal outcomes of dialysis‐dependent patients undergoing isolated coronary artery bypass grafting. J Card Surg 2019; 34:110-117. [DOI: 10.1111/jocs.13991] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 01/24/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Valentino Bianco
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryUniversity of PittsburghPittsburgh Pennsylvania
| | - Arman Kilic
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryUniversity of PittsburghPittsburgh Pennsylvania
- Heart and Vascular Institute, University of Pittsburgh Medical CenterPittsburgh Pennsylvania
| | - Thomas G. Gleason
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryUniversity of PittsburghPittsburgh Pennsylvania
- Heart and Vascular Institute, University of Pittsburgh Medical CenterPittsburgh Pennsylvania
| | - Edgar Aranda‐Michel
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryUniversity of PittsburghPittsburgh Pennsylvania
| | - Forozan Navid
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryUniversity of PittsburghPittsburgh Pennsylvania
- Heart and Vascular Institute, University of Pittsburgh Medical CenterPittsburgh Pennsylvania
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryUniversity of PittsburghPittsburgh Pennsylvania
- Heart and Vascular Institute, University of Pittsburgh Medical CenterPittsburgh Pennsylvania
| |
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW This review article focuses on the most significant cardiovascular complications in dialysis patients [sudden cardiac death (SCD), acute coronary syndromes, heart failure, and atrial fibrillation]. RECENT FINDINGS Current and ongoing research aims to quantify the rate and pattern of significant arrhythmia in dialysis patients and to determine the predominant mechanism of SCD. Preliminary findings from these studies suggest a high rate of atrial fibrillation and that bradycardia and asystole may be more frequent than ventricular arrhythmia as a cause of sudden death. A recently published matched cohort study in dialysis patients who received a defibrillator for primary prevention showed that there was no significant difference in mortality rates between defibrillator-treated patients and propensity-matched controls. Two randomized controlled trials are currently recruiting participants and will hopefully answer the question of whether implantable or wearable cardioverter defibrillators can prevent SCD. An observational study using United States Renal Data System data demonstrated how difficult it is to keep hemodialysis patients on warfarin, as more than two-thirds discontinued the drug during the first year. The ISCHEMIA-CKD trial may provide answers about the optimal strategy for the treatment of atherosclerotic coronary disease in patients with advanced chronic kidney disease. SUMMARY The article reviews the diagnosis of acute coronary syndromes in dialysis patients, current literature on myocardial revascularization, and data on fatal and nonfatal cardiac arrhythmia. The new classification of heart failure in end-stage renal disease is reviewed. Finally, available cohort studies on warfarin for stroke prevention in dialysis patients with atrial fibrillation are reviewed.
Collapse
|
14
|
Shen W, Aguilar R, Montero AR, Fernandez SJ, Taylor AJ, Wilcox CS, Lipkowitz MS, Umans JG. Acute Kidney Injury and In-Hospital Mortality after Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention: A Nationwide Study. Am J Nephrol 2017; 45:217-225. [PMID: 28135709 DOI: 10.1159/000455906] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/03/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Post-procedural acute kidney injury (AKI) is associated with significantly increased short- and long-term mortalities, and renal loss. Few studies have compared the incidence of post-procedural AKI and in-hospital mortality between 2 major modalities of revascularization - coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) - and results have been inconsistent. METHODS We generated a propensity score-matched cohort that includes a total of 286,670 hospitalizations with multi-vessel coronary disease undergoing CABG or PCI (2004-2012) from the National Inpatient Sample database. We compared incidence of AKI, AKI requiring renal replacement therapy (RRT), in-hospital mortality, hospital stay, and charges between CABG and PCI groups. RESULTS The incidence of AKI after CABG was higher than PCI (8.9 vs. 4.5%, OR 2.05, 95% CI 1.99-2.12, p < 0.001). The incidence of AKI requiring RRT was also higher after CABG (1.1 vs. 0.5%, OR 2.14, 95% CI 1.96-2.34, p < 0.001). Likewise, in-hospital mortality was higher after CABG than PCI (2.0 vs. 1.4%, OR 1.44, 95% CI 1.35-1.52, p < 0.001). Among patients with pre-existing chronic kidney disease (stages I-IV), those undergoing CABG was associated with 2.0-2.3-fold higher odds of developing AKI than those undergoing PCI. The patients treated with CABG had a significantly longer hospital stay and higher hospital charges. CONCLUSIONS Patients undergoing CABG are associated with (1) increased risk of developing post-procedural AKI, (2) higher likelihood of receiving RRT, and (3) worse short-term survival. Long-term renal outcome remains to be studied.
Collapse
Affiliation(s)
- Wen Shen
- Division of Nephrology and Hypertension, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Altarabsheh SE, Deo SV, Dunlay SM, Obeidat YM, Erwin PJ, Rababa'h A, Sarabhu N, Navale S, Cho YH, Lamba HK, Markowitz AH, Park SJ. Tissue valves are preferable for patients with end-stage renal disease: an aggregate meta-analysis. J Card Surg 2016; 31:507-14. [PMID: 27389823 DOI: 10.1111/jocs.12805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Valve selection in patients with end-stage renal disease (ESRD) is uncertain. We performed a systematic review and meta-analysis to compare clinical outcome in ESRD patients undergoing valve replacement. METHODS We systematically searched multiple databases (2000-October 2015) to identify original studies comparing adverse events between mechanical and biological valve replacement in ESRD patients. End-points studied were: postoperative mortality, bleeding events, need for re-operation, and late survival. A random-effect inverse-variance weighted analysis was performed; event rates are compared as odds ratio (OR and 95% confidence interval) and hazard ratios (HR) for time-to-event data. Mechanical valve and tissue valve replacement were considered as study and control cohorts, respectively. RESULTS Fifteen retrospective studies (5523 mechanical and 1600 tissue valve) were included in our meta-analysis. Early mortality was comparable (OR 1.15 [0.77; 1.72]; p = 0.49). The mean follow-up among studies ranged from 1.6-15 years. Bleeding was significantly higher after mechanical valve replacement (OR 2.55 [1.53; 4.26]; p = 0.0003). Structural valve degeneration was present in only 0.6% patients after a tissue valve replacement. Overall survival after valve replacement was poor (median 2.61 years); valve choice did not influence this outcome (pooled HR 0.87 [0.73; 1.04]; p = 0.14). CONCLUSION Operative mortality in ESRD patients is comparable between mechanical and tissue valve replacement. Major bleeding episodes are significantly higher after mechanical valve replacement but structural degeneration in tissue valves during the follow-up period is low. Based on the findings from this meta-analysis, we would recommend using tissue valves in patients with ESRD.
Collapse
Affiliation(s)
- Salah E Altarabsheh
- Department of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
| | - Salil V Deo
- Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | | | - Yaqthan M Obeidat
- Department of Cardiac Surgery, Al-Mouwasat Hospital, Al-Dammam, Kingdom of Saudi Arabia
| | | | - Abeer Rababa'h
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Suparna Navale
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
| | - Yang Hyun Cho
- Division of Cardiovascular Surgery, Samsung Hospitals, Sungkyunkwang School of Medicine, Seoul, South Korea
| | - Harveen K Lamba
- Department of Cardiothoracic Surgery, Louis Stokes Veterans Affairs, Cleveland, Ohio
| | - Alan H Markowitz
- Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | - Soon J Park
- Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| |
Collapse
|
16
|
Lee HF, Wu LS, Chan YH, Lee CH, Liu JR, Tu HT, Wen MS, Kuo CT, Chen WJ, Yeh YH, See LC, Chang SH. Dialysis Patients with Implanted Drug-Eluting Stents Have Lower Major Cardiac Events and Mortality than Those with Implanted Bare-Metal Stents: A Taiwanese Nationwide Cohort Study. PLoS One 2016; 11:e0146343. [PMID: 26731408 PMCID: PMC4711720 DOI: 10.1371/journal.pone.0146343] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/15/2015] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To investigate the efficacy and long-term clinical benefits of DES for dialysis patients. BACKGROUND It is unclear whether percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation is associated with lower rates of major adverse cardiovascular events (MACE) or mortality compared to bare-metal stents (BMS). METHODS From a nationwide cohort selected from Taiwan's National Health Insurance Research Database, we enrolled 2,835 dialysis patients who were hospitalized for PCI treatment with stent implantation from Dec 1, 2006. Follow-up was from the date of index hospitalization for PCI until the first MACE, date of death, or December 31, 2011, whichever came first. RESULTS A total of 738 patients (26.0%) had DES implanted, and 2,097 (74%) had BMS implanted. The medium time to the first MACE was 0.53 years (interquartile range: 0.89 years; range: 0-4.62 years). At 1-year follow-up, patients treated with BMS had significantly, non-fatal myocardial infarction (MI), all-cause mortality, and composite MACE compared to those treated with DES. The overall repeat revascularization with coronary artery bypass graft (CABG), non-fatal MI, all-cause mortality, and composite MACE were significantly lower in patients treated with DES than those treated with BMS. Multivariate cox regression analysis showed that older age, history of diabetes, history of heart failure, history of stroke, and DES vs. BMS were independent significant predictors of MACE. CONCLUSIONS DES implantation conferred survival benefits in dialysis patients compared with BMS implantation.
Collapse
Affiliation(s)
- Hsin-Fu Lee
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Lung-Sheng Wu
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Yi-Hsin Chan
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Cheng-Hung Lee
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Jia-Rou Liu
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hui-Tzu Tu
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shien Wen
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chi-Tai Kuo
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Wei-Jan Chen
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Yung-Hsin Yeh
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan
- * E-mail: (LCS); (SHC)
| | - Shang-Hung Chang
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
- * E-mail: (LCS); (SHC)
| |
Collapse
|
17
|
Chan W, Ivanov J, Ko D, Fremes S, Rao V, Jolly S, Cantor WJ, Lavi S, Overgaard CB, Ruel M, Tu JV, Džavík V. Clinical outcomes of treatment by percutaneous coronary intervention versus coronary artery bypass graft surgery in patients with chronic kidney disease undergoing index revascularization in Ontario. Circ Cardiovasc Interv 2015; 8:CIRCINTERVENTIONS.114.001973. [PMID: 25582144 DOI: 10.1161/circinterventions.114.001973] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a paucity of data on the comparative effectiveness of percutaneous coronary intervention using contemporary drug-eluting stent (DES) compared with coronary artery bypass graft (CABG) surgery in patients with chronic kidney disease. METHODS AND RESULTS A population-based study was performed using the Cardiac Care Network, a provincial registry of all patients undergoing cardiac catheterization in Ontario, to evaluate patients treated with either percutaneous coronary intervention using DES or CABG between October 1, 2008, and September 30, 2011. Chronic kidney disease was defined as creatinine clearance <60 mL/min. A total of 1786 propensity-matched patients from 4006 patients with chronic kidney disease undergoing index revascularization for multivessel disease with either DES or isolated CABG (n=893 each group) were analyzed. Baseline and procedural characteristics between percutaneous coronary intervention and CABG groups were well-balanced, including urgent revascularization priority, diabetes mellitus, left ventricular function, and 3-vessel disease. The 1-, 2-, and 3-year Kaplan-Meier survival analyses in propensity-matched patients favored CABG (93.2% versus 89.3%; 86.6% versus 80.3%; 80.8% versus 71.5%, respectively; P<0.001). The CABG cohort had greater 1-, 2-, and 3-year freedom from major adverse cardiac and cerebrovascular events (89.4% versus 71.2%; 81.9% versus 60.5%; 75.2% versus 51.8%, respectively; P<0.001). Cox regression analysis identified DES use to be associated with greater hazard for late mortality (hazard ratio, 1.58; 95% confidence interval, 1.32-1.90) and major adverse cardiac and cerebrovascular events (2.62; 2.28-3.01; all P<0.001). CONCLUSIONS In this large provincial registry, CABG was associated with improved early and late clinical outcomes when compared with percutaneous coronary intervention using DES in patients with chronic kidney disease undergoing index revascularization.
Collapse
Affiliation(s)
- William Chan
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Joan Ivanov
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Dennis Ko
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Stephen Fremes
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Vivek Rao
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Sanjit Jolly
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Warren J Cantor
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Shahar Lavi
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Christopher B Overgaard
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Marc Ruel
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Jack V Tu
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Vladimír Džavík
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.).
| |
Collapse
|
18
|
Choi HY, Park HC, Ha SK. How do We Manage Coronary Artery Disease in Patients with CKD and ESRD? Electrolyte Blood Press 2014; 12:41-54. [PMID: 25606043 PMCID: PMC4297703 DOI: 10.5049/ebp.2014.12.2.41] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 12/05/2014] [Indexed: 12/11/2022] Open
Abstract
Chronic kidney disease (CKD) has been shown to be an independent risk factor for cardiovascular events. In addition, patients with pre-dialysis CKD appear to be more likely to die of heart disease than of kidney disease. CKD accelerates coronary artery atherosclerosis by several mechanisms, notably hypertension and dyslipidemia, both of which are known risk factors for coronary artery disease. In addition, CKD alters calcium and phosphorus homeostasis, resulting in hypercalcemia and vascular calcification, including the coronary arteries. Mortality of patients on long-term dialysis therapy is high, with age-adjusted mortality rates of about 25% annually. Because the majority of deaths are caused by cardiovascular disease, routine cardiac catheterization of new dialysis patients was proposed as a means of improving the identification and treatment of high-risk patients. However, clinicians may be uncomfortable exposing asymptomatic patients to such invasive procedures like cardiac catheterization, thus noninvasive cardiac risk stratification was investigated widely as a more palatable alternative to routine diagnostic catheterization. The effective management of coronary artery disease is of paramount importance in uremic patients. The applicability of diagnostic, preventive, and treatment modalities developed in nonuremic populations to patients with kidney failure cannot necessarily be extrapolated from clinical studies in non-kidney failure populations. Noninvasive diagnostic testing in uremic patients is less accurate than in nonuremic populations. Initial data suggest that dobutamine echocardiography may be the preferred diagnostic method. PCI with stenting is a less favorable alternative to CABG, however, it has a faster recovery time, reduced invasiveness, and no overall mortality difference in nondiabetic and non-CKD patients compared with CABG. CABG is associated with reduced repeat revascularizations, greater relief of angina, and increased long term survival. However, CABG is associated with a higher incidence of post-operative risks. The treatment chosen for each patient should be an individualized decision based upon numerous risk factors. CKD is associated with higher rates of CAD, with 44% of all-cause mortality attributable to cardiac disease and about 20% from acute MI. Optimal treatment including aggressive lifestyle modifications and concomitant medical therapy should be implemented in all patients to maximize benefits from either PCI or CABG. Future prospective randomized controlled trials with newer second or third generation DES and bioabsorbable DES are necessary to determine if PCI may be non-inferior to CABG in the future.
Collapse
Affiliation(s)
- Hoon Young Choi
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeong Cheon Park
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Kyu Ha
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
19
|
Charytan DM. How is the heart best protected in chronic dialysis patients?: Between Scylla and Charybdis: what is the appropriate role for percutaneous coronary revascularization and coronary artery bypass grafting in patients on dialysis? Semin Dial 2014; 27:325-8. [PMID: 24438072 DOI: 10.1111/sdi.12181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- David M Charytan
- Renal Division, Brigham & Women's Hospital, Boston, Massachusetts
| |
Collapse
|
20
|
Vohra HA, Armstrong LA, Modi A, Barlow CW. Outcomes following cardiac surgery in patients with preoperative renal dialysis. Interact Cardiovasc Thorac Surg 2013; 18:103-11. [PMID: 24057861 DOI: 10.1093/icvts/ivt407] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was that whether patients who are dependent on chronic dialysis have higher morbidity and mortality rates than the general population when undergoing cardiac surgery. These patients often require surgery in view of their heightened risk of cardiac disease. Altogether 278 relevant papers were identified using the below mentioned search, 16 papers represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. Dialysis-dependent (DD) patients undergoing coronary artery bypass grafting (CABG) or valve replacement have higher morbidity but acceptable outcomes. There is some evidence to show that outcomes after off-pump coronary artery bypass grafting (OPCAB) are better than after on-pump coronary artery bypass grafting (ONCAB) and that results are worse in DD patients with diabetic nephropathy. Patients undergoing combined procedures have a higher mortality.
Collapse
Affiliation(s)
- Hunaid A Vohra
- Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton, UK
| | | | | | | |
Collapse
|
21
|
Ivert T, Holzmann MJ, Sartipy U. Survival in patients with acute kidney injury requiring dialysis after coronary artery bypass grafting. Eur J Cardiothorac Surg 2013; 45:312-7. [DOI: 10.1093/ejcts/ezt247] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
|
22
|
Abstract
The burden of cardiovascular disease is high in patients with chronic kidney disease or end-stage renal disease. The presence of kidney dysfunction affects the cardiovascular system in multiple ways, including accelerated progression of atherosclerosis and valvular disease, the exacerbation of congestive heart failure, and the development of pericardial disease. This comorbidity results not only from the concordance of shared risk factors, but also from other issues specific to this population, such as systemic inflammation and vascular calcification. Furthermore, both the sensitivity and specificity of noninvasive testing modalities, and the efficacy of several pharmacotherapeutic strategies, are diminished in this population. The exclusion of patients with severe kidney disease from many clinical trials of cardiac interventions raises various therapeutic uncertainties, and kidney disease itself is likely to alter the underlying cardiovascular physiology. In this Review, we discuss aspects of the epidemiology, pathophysiology, and diagnosis of cardiovascular disease in patients with kidney disease, and propose specific, evidence-based recommendations for pharmacological and surgical treatment.
Collapse
|
23
|
Efird JT, O'Neal WT, Gouge CA, Kindell LC, Kennedy WL, Bolin P, O'Neal JB, Anderson CA, Rodriguez E, Ferguson TB, Chitwood WR, Kypson AP. Implications of Hemodialysis in Patients Undergoing Coronary Artery Bypass Grafting. ACTA ACUST UNITED AC 2013; 2. [PMID: 25309935 DOI: 10.4172/2324-8602.1000154] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of morbidity and mortality in patients on hemodialysis. To our knowledge, no studies have examined long-term outcomes of hemodialysis patients following coronary artery bypass grafting (CABG) in a predominately rural, low-income, and racially dichotomous population. METHODS Long-term survival of hemodialysis patients undergoing non-emergent, isolated CABG was compared with non-hemodialysis patients. Survival probabilities were computed using the Kaplan-Meier product limit method and stratified by hemodialysis. Hazard ratios (HR) and 95% confidence intervals (95%CI) were computed using a Cox regression model. RESULTS Hemodialysis patients (n=220) had shorter long-term survival than non-hemodialysis patients (median survival=3.3 versus 14 years, p<0.0001). The survival difference remained statistically significant after adjusting for clinically relevant variables (HR=5.2, 95%CI=4.4-6.2). CONCLUSION Hemodialysis patients had significantly shorter long-term survival compared with non-hemodialysis patients after CABG. Further research is needed to address the cost and policy implications of our findings, especially among priority populations.
Collapse
Affiliation(s)
- Jimmy T Efird
- Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA ; Center for Health Disparity Research, East Carolina University, USA
| | - Wesley T O'Neal
- Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA
| | - Catherine A Gouge
- Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA
| | - Linda C Kindell
- Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA
| | - Whitney L Kennedy
- Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA
| | - Paul Bolin
- Department of Internal of Medicine, Division of Nephrology and Hypertension. Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Jason B O'Neal
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Curtis A Anderson
- Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA
| | | | - T Bruce Ferguson
- Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA
| | - W Randolph Chitwood
- Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA
| | - Alan P Kypson
- Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA
| |
Collapse
|
24
|
Chikuda H, Yasunaga H, Horiguchi H, Takeshita K, Kawaguchi H, Matsuda S, Nakamura K. Mortality and morbidity in dialysis-dependent patients undergoing spinal surgery: analysis of a national administrative database in Japan. J Bone Joint Surg Am 2012; 94:433-8. [PMID: 22398737 DOI: 10.2106/jbjs.k.00183] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The impact of dialysis dependence on perioperative risks following spinal surgery is not fully understood. The purposes of the present study were to determine the perioperative risks in dialysis-dependent patients treated with spinal surgery and to examine whether the presence of destructive spondyloarthropathy further increases perioperative risks. METHODS We examined abstracted data from the Diagnosis Procedure Combination database in a retrospective analysis of a nationally representative inpatient database. The survey of the database is conducted annually for a six-month period between July 1 and December 31. The data from 2007 and 2008 were used for this study. We included all patients who had undergone any combination of laminectomy, laminoplasty, discectomy, and/or spinal arthrodesis. For analysis, dialysis-dependent patients were further classified into subgroups with or without destructive spondyloarthropathy. RESULTS We identified 51,648 eligible patients (30,743 men and 20,905 women; mean age, sixty-two years), including 869 (1.7%) who were dialysis-dependent. Of the latter, ninety-five had destructive spondyloarthropathy. Overall in-hospital mortality was 0.41%. Dialysis-dependent patients had a significantly higher in-hospital mortality rate than non-dialysis-dependent patients. After adjustment, dialysis-dependent patients remained at a tenfold higher risk for in-hospital death. Dialysis-dependent patients were also at significantly greater risk for postoperative major complications. The rate of complications in dialysis-dependent patients with destructive spondyloarthropathy was 65% higher than that in those without destructive spondyloarthropathy, but this difference did not reach significance. CONCLUSIONS Dialysis-dependent patients had a tenfold higher risk of in-hospital death than did non-dialysis-dependent patients. Dialysis-dependent patients were also more likely to have major complications such as cardiac events, sepsis, and respiratory complications. Our data also indicate that the presence of destructive spondyloarthropathy is associated with a higher rate of postoperative complications in dialysis-dependent patients.
Collapse
Affiliation(s)
- Hirotaka Chikuda
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | | | | | | | | | | | | |
Collapse
|
25
|
Yamauchi T, Miyata H, Sakaguchi T, Miyagawa S, Yoshikawa Y, Takeda K, Motomura N, Tsukihara H, Sawa Y. Coronary Artery Bypass Grafting in Hemodialysis-Dependent Patients. Circ J 2012; 76:1115-20. [DOI: 10.1253/circj.cj-11-1146] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takashi Yamauchi
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Koji Takeda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Noboru Motomura
- Department of Cardiac Surgery, Faculty of Medicine, Graduate School of Medicine, University of Tokyo
| | - Hiroyuki Tsukihara
- Department of Cardiac Surgery, Faculty of Medicine, Graduate School of Medicine, University of Tokyo
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| |
Collapse
|
26
|
Abstract
Despite a substantial number of patients with end-stage renal disease who have coronary artery disease, the comparative effectiveness of revascularization procedures such as coronary artery bypass grafting and percutaneous coronary intervention remain unclear. Innovations in the field of coronary artery revascularization and concomitant changes in the standard of practice have improved outcomes in general. However, meaningful clinical decision-making remains difficult because it requires clinicians to extrapolate evidence derived from studies in the general population to patients with kidney disease for whom there is limited information from intervention trials. In non-randomized studies, this high-risk population for cardiovascular morbidity and mortality appear to derive substantial benefits from coronary revascularization. However, specific treatment decisions are often made based upon individual circumstances and contexts that are not well captured in these studies. This article reviews the available evidence, and its limitations, for deciding between various revascularization strategies for patients with end-stage renal disease. Several considerations that arise while making such decisions are discussed.
Collapse
Affiliation(s)
- John K Roberts
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | | |
Collapse
|
27
|
Herzog CA, Asinger RW, Berger AK, Charytan DM, Díez J, Hart RG, Eckardt KU, Kasiske BL, McCullough PA, Passman RS, DeLoach SS, Pun PH, Ritz E. Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2011; 80:572-86. [PMID: 21750584 DOI: 10.1038/ki.2011.223] [Citation(s) in RCA: 611] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD) is high, and the presence of CKD worsens outcomes of cardiovascular disease (CVD). CKD is associated with specific risk factors. Emerging evidence indicates that the pathology and manifestation of CVD differ in the presence of CKD. During a clinical update conference convened by the Kidney Disease: Improving Global Outcomes (KDIGO), an international group of experts defined the current state of knowledge and the implications for patient care in important topic areas, including coronary artery disease and myocardial infarction, congestive heart failure, cerebrovascular disease, atrial fibrillation, peripheral arterial disease, and sudden cardiac death. Although optimal strategies for prevention, diagnosis, and management of these complications likely should be modified in the presence of CKD, the evidence base for decision making is limited. Trials targeting CVD in patients with CKD have a large potential to improve outcomes.
Collapse
|
28
|
Matsuo A, Fujita H, Ueoka A, Maruyama N, Shimoda Y, Kishita E, Tsubakimoto Y, Sakatani T, Inoue K, Kitamura M, Nishimura M. Importance of measuring the fractional flow reserve in patients receiving hemodialysis. Cardiovasc Interv Ther 2011; 26:215-21. [DOI: 10.1007/s12928-011-0061-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Accepted: 03/06/2011] [Indexed: 11/30/2022]
|
29
|
Abdel-Latif A, Mukherjee D, Mesgarzadeh P, Ziada KM. Drug-eluting stents in patients with end-stage renal disease: Meta-analysis and systematic review of the literature. Catheter Cardiovasc Interv 2010; 76:942-8. [DOI: 10.1002/ccd.22562] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
30
|
Miller LM, Sood MM, Sood AR, Reslerova M, Komenda P, Rigatto C, Bueti J. Cardiovascular disease in end-stage renal disease: the challenge of assessing and managing cardiac disease in dialysis patients. Int Urol Nephrol 2010; 42:1007-14. [PMID: 20960231 DOI: 10.1007/s11255-010-9857-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 09/23/2010] [Indexed: 11/25/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality in end-stage renal disease (ESRD), approximating a 10- to 20-fold higher risk of death in dialysis patients than in the general population. Despite this, dialysis patients often undergo fewer investigations, receive less invasive procedures, and are prescribed fewer medications compared with age-matched non-ESRD patients. A lack of randomized control trials for evidence-based treatment strategies in this population may explain some of these discrepancies, but there is concern that an attitude of "therapeutic nihilism" may be impacting on the medical care of these patients. In this review, we will explore CVD in the ESRD population. Specifically, we will try to address the following issues in patients with ESRD: (1) mechanisms of CVD, (2) cardiac evaluation and the role of coronary revascularization with percutaneous or coronary artery bypass procedures, and (3) cardiac pharmacotherapy use.
Collapse
Affiliation(s)
- Lisa M Miller
- Department of Medicine, Health Sciences Centre, GE-441, 820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada.
| | | | | | | | | | | | | |
Collapse
|
31
|
Hedley AJ, Roberts MA, Hayward PA, Shaw M, Matalanis G, Buxton BF, Farouque O, Ierino FL. Impact of Chronic Kidney Disease on Patient Outcome following Cardiac Surgery. Heart Lung Circ 2010; 19:453-9. [DOI: 10.1016/j.hlc.2010.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 03/10/2010] [Indexed: 10/19/2022]
|
32
|
Chikwe J, Castillo JG, Rahmanian PB, Akujuo A, Adams DH, Filsoufi F. The Impact of Moderate–to–End-Stage Renal Failure on Outcomes After Coronary Artery Bypass Graft Surgery. J Cardiothorac Vasc Anesth 2010; 24:574-9. [DOI: 10.1053/j.jvca.2009.10.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Indexed: 11/11/2022]
|
33
|
Charytan DM, Yang SS, McGurk S, Rawn J. Long and short-term outcomes following coronary artery bypass grafting in patients with and without chronic kidney disease. Nephrol Dial Transplant 2010; 25:3654-63. [DOI: 10.1093/ndt/gfq328] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
|
34
|
Ziada KM, Abdel-Latif A. Drug-eluting stents in patients with ESRD on dialysis: a small step forward. Am J Kidney Dis 2009; 54:197-200. [PMID: 19619843 DOI: 10.1053/j.ajkd.2009.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 05/07/2009] [Indexed: 11/11/2022]
|
35
|
Zhong H, David T, Zhang AH, Fang W, Ahmad M, Bargman JM, Oreopoulos DG. Coronary artery bypass grafting in patients on maintenance dialysis: is peritoneal dialysis a risk factor of operative mortality? Int Urol Nephrol 2008; 41:653-62. [PMID: 19048383 DOI: 10.1007/s11255-008-9507-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 11/11/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increasing numbers of patients on dialysis are undergoing coronary artery bypass grafting (CABG). We undertook this retrospective study to identify risk factors of operative mortality in dialysis patients who underwent CABG. PATIENTS AND METHODS We performed retrospective analysis of 105 patients who were on dialysis for at least two months before surgery and who underwent CABG in Toronto General Hospital from 1997 to 2006. Using prospectively collected data from the Division of Cardiovascular Surgery Database of Toronto General Hospital, we collected data on comorbidities, procedures, modality change during hospitalization, and operative outcomes. Logistic regression was used to assess risk factors of operative mortality. RESULTS One hundred and five maintenance dialysis patients (40 PD and 65 HD) who met the inclusion criteria were studied. Overall in-hospital mortality was 7.6%. Atrial fibrillation and pneumonia occurred in 16.2 and 9.5%, respectively, of all dialysis patients. Among PD patients, rates of post-operative dialysate leak and peritonitis were 10 and 12.5%, respectively. Among HD patients, 4.6% experienced post-operative AV access thrombosis. Logistic regression showed older age (>or=70 years) and peritoneal dialysis are independent risk factors of operative mortality. CONCLUSION In this retrospective study, older patients on PD had higher operative mortality than HD patients. These findings suggest extra care should be taken when CABG is considered for PD patients over 70 years old. In this study we could not identify the reason(s) for the high mortality of elderly peritoneal dialysis patients undergoing CABG.
Collapse
Affiliation(s)
- Hui Zhong
- Department of Medicine, Division of Nephrology, University Health Network and University of Toronto, Toronto, ON, Canada.
| | | | | | | | | | | | | |
Collapse
|
36
|
Filsoufi F, Chikwe J, Castillo JG, Rahmanian PB, Vassalotti J, Adams DH. Prosthesis type has minimal impact on survival after valve surgery in patients with moderate to end-stage renal failure. Nephrol Dial Transplant 2008; 23:3613-21. [PMID: 18606623 DOI: 10.1093/ndt/gfn337] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Farzan Filsoufi
- Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA.
| | | | | | | | | | | |
Collapse
|
37
|
Rahmanian PB, Adams DH, Castillo JG, Vassalotti J, Filsoufi F. Early and late outcome of cardiac surgery in dialysis-dependent patients: Single-center experience with 245 consecutive patients. J Thorac Cardiovasc Surg 2008; 135:915-22. [DOI: 10.1016/j.jtcvs.2007.09.027] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 08/22/2007] [Accepted: 09/12/2007] [Indexed: 11/30/2022]
|
38
|
Sherman RA. Briefly noted. Semin Dial 2007. [DOI: 10.1111/j.1525-139x.2007.00364.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
39
|
Abstract
Advanced coronary artery disease and acute cardiac events are the most common causes of death in patients with end-stage renal disease. Because of their heightened risk, end-stage renal disease patients are frequently referred for coronary revascularization. However, these patients are almost always excluded from trials examining various innovations in medical and revascularization interventions for cardiovascular conditions. Extrapolation of trial conclusions regarding dialysis patients can be misleading because the risk-benefit ratios of various interventions in this patient population can be markedly different. Thus, clinical decisions regarding the need for (and type of) coronary revascularization are based on retrospective outcome analyses from various databases. This article reviews the data available in the literature on the morbidity, mortality, and outcomes of dialysis patients undergoing surgical or percutaneous revascularization, particularly with the addition of drug-eluting stents to the available therapeutic options.
Collapse
Affiliation(s)
- Khaled M Ziada
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY 40536, USA.
| |
Collapse
|