Abstract: TH-PO865

PD Patients Undergoing CABG: Modality Change and Complications

Session Information

  • Peritoneal Dialysis - I
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Diamond, Matthew J., Augusta University, Augusta, Georgia, United States
  • Nahman, N. Stanley, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
  • Waller, Jennifer L., Augusta University, Augusta, Georgia, United States
  • Kheda, Mufaddal F., Augusta University, Augusta, Georgia, United States
  • Baer, Stephanie L, Augusta VA Medical Center, Augusta, Georgia, United States
  • Colombo, Rhonda E., Augusta University, Augusta, Georgia, United States
  • Huber, Lu, Augusta University, Augusta, Georgia, United States
  • White, John Jason, Augusta University, Augusta, Georgia, United States
  • Day, Matt, Augusta University, Augusta, Georgia, United States
  • Plumb, Troy J., University of Nebraska Medical Center, Omaha, Nebraska, United States
Background

Efforts to continue PD when patients undergo CABG may minimize infectious and thoracic complications of temporary HD, alleviate interruptions in therapy, and be more cost effective. To investigate patterns of modality change and post-op complications in PD patients undergoing CABG, we queried the USRDS.

Methods

Incident PD patients from 2004 – 2011 (n=56,192) who underwent CABG were studied. Groups included: no interruption of PD (PD); planned temporary (PT) HD then back to PD (PTHD-->PD); permanent switch (PS) to HD (PSHD); urgent temporary (UT) HD then back to PD (UTHD-->PD); or urgent (U) HD with PS to HD (UHD-->PSHD). Demographics and outcomes were determined. The relative risk (RR) of complications of interruption of PD vs. no interruption of PD up to 90 days post-op were estimated.

Results

1259 PD patients had CABG, 63% men, 79% White, with mean+SD age 61+2 years, and time on dialysis of 24.1+2.7 months. Readmissions 90 days post-op (Re-adm90, number), and group comparisons by complication, are shown in the table.Continuing PD, and planned temporary HD (PTHD-->PD), were the most common forms of dialysis in PD patients with CABG. However, planned or urgent HD that returns to PD had the most readmissions, and when compared to those staying on PD, had the greatest risk of complications.

Conclusion

Continuing PD during CABG appears safe. A planned permanent switch to HD had the fewest readmissions and a non-significant tendency toward lower complication rates. Restarting PD after planned or urgent HD has a high complication rate. Risk stratification my help identify the best candidates for returning to PD post-CABG.

Readmission data, dialysis modality, and Relative Risk (RR) of complications amongst incident PD patients receiving CABG (2004-11)

Funding

  • Clinical Revenue Support