Abstract: FR-PO800
Coronary Artery Bypass Grafting (CABG) Is Not Associated with Worse Outcomes in Dialysis Patients
Session Information
- Standard Hemodialysis for ESRD - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 601 Standard Hemodialysis for ESRD
Authors
- Silva, Sirlei, Universidade de São Paulo, SAO PAULO, SP, Brazil
- Moyses, Rosa M.A., Universidade de São Paulo, SAO PAULO, SP, Brazil
- Elias, Rosilene M., Universidade de São Paulo, SAO PAULO, SP, Brazil
Background
CABG is currently a good option of treatment for dialysis patients with multivessel coronary artery involvement. However, whether this population has a higher risk of Hospital worse outcomes than patients with normal renal function and patients with chronic kidney disease (CKD) not on dialysis is still debatable.
Methods
This is a prospective observational study to compare hospital mortality of patients who underwent elective CABG. Consecutive non-selected patients were included in the group with normal renal function (control; N=167), CKD with eGFR 30-60 ml/min (CKD30-60; N=78) and on maintenance dialysis (CKD5D; N=31). Demographic, clinical, biochemical and also fluid balance were evaluated in all patients from the day 1 (surgery) to the day 30 of admission. Sequential Organ Failure Assessment (SOFA) scores at intensive care unit (ICU) admission were also assessed.
Results
Age was similar among control, CKD30-60 and CKD5D groups (63±10, 63±9 and 65±6 years, respectively, p=0.585). Patients from the control group had less diabetes (p=0.019) and Hypertension (p=0.010) than other groups, although dyslipidemia, smoking and previous history of coronary disease did not differ significantly. Initial SOFA scores were higher when renal component was considered (0.3±0.6, 1.1±0.8 and 4.2±1.0 in groups control, CKD30-60 and CKD5D respectively, p=0.0001), though this difference disappeared when renal component was dismissed (p=0.507). Surgery time was similar among groups (p>0.05); endotracheal intubation time was shorter in the control group (p=0.001) as well as intensive care discharge time (p=0.002). There were 17 deaths in 30 days of admission that occurred in the ICU (7 from control, 7 from CKD30-60 and 2 patients from CKD5D; p=0.264). Kaplan-Meier curve showed no 30-day hospital mortality difference among groups (log-rank test 0.977), which was confirmed by Cox-regression survival analysis adjusted for age, diabetes and initial SOFA.
Conclusion
The CABG predictable short-term mortality seems not to be inferior among selected patients on maintenance dialysis. This is probably due to quality improvements in the in cardiologic centers and also because dialysis can be routinely planned in this population.