Abstract: SA-PO522
Rates and Outcomes of Cardiac Surgery for People Receiving Long-Term Dialysis or Kidney Transplantation in Australia
Session Information
- Hypertension and CVD: Clinical - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- McDonald, Stephen P., Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia
- Keuskamp, Dominic, Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia
- Davies, Christopher E., Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia
- Smith, Julian A., Monash University, Clayton, Victoria, Australia
- Baker, Robert Ashley, Flinders University, Adelaide, South Australia, Australia
- Reid, Christopher M., Monash University, Clayton, Victoria, Australia
- Williams-Spence, Jenni, Monash University, Clayton, Victoria, Australia
- Tran, Lavinia, Monash University, Clayton, Victoria, Australia
- Polkinghorne, Kevan, Monash University, Clayton, Victoria, Australia
Background
Rates of coronary artery disease and cardiac valve disorders are higher among people with kidney failure (KF). Cardiac surgery (CS - coronary artery bypass grafting [CABG] and valve replacement surgery) are important treatment options for these, but may carry substantial risks. Utilising data linkage of two registries with national coverage, we examined rates and outcomes of CS among patients receiving long term dialysis or with a kidney transplant.
Methods
Data were linked probabilistically between the Australia & New Zealand Dialysis & Transplant Registry and the Australian & New Zealand Society of Cardiac & Thoracic Surgeons Cardiac Surgery Database. Thirty-day mortality adjusted for risk factors was compared for 3 groups based on status at time of surgery (dialysis / kidney transplant / non-kidney failure [KF]) using multiple logistic regression. The study population included all eligible CS in Australia from 2001-2019.
Results
Demographics are shown in the Table. Crude 30-day mortality was highest among the dialysis group then the transplant and non-KF groups. Mortality progressively improved over time. Adjusted for procedure type and other comorbidites, excess mortality persisted for the KF groups. The odds ratio for 30 day mortality for CS in the dialysis group was 3.4 [2.7-4.2] and for the transplant group was 2.4 [1.4-4.2]. Adjusted analyses showed increased risk of mortality were seen for valve replacement (vs CABG), urgent surgery, comorbidities and those with greater dialysis vintage. Mortality at 24 months was 32 [29-35]% for the dialysis group and 16 [12-20]% for the transplant group.
Conclusion
Among KF patients requiring CS, early mortality rates are substantially increased, especially when other comorbidities are present or surgery is urgent. While the risks of not operating are not known for these cohort, these data will inform and support careful consideration of the risks of cardiac surgery in this group.
| Dialysis | Transplant | Non-KF | |
| Number | 1639 (74% male) | 353 (75% male) | 150741 (73% male) |
| Age (median (IQR) ; years) | 63 (55-71) | 64 (55-69) | 68 (59-71) |
| Diabetes (%) | 58 | 44 | 29 |
| Procedure type (Isolated CABG / Isolated valve replacement / combined) | 955/301/244 | 131/98/55 | 80606/30754/15298 |
| Unadjusted 30 day mortality [95% CI] | 6.5 [5.3-7.8]% | 4.5 (26-7.3)% | 2.2 (2.1-2.3)% |
Funding
- Government Support – Non-U.S.