Among CRF patients, those requiring dialysis are not more likely to die.
DENVER—Hemodialysis (HD)-dependent chronic renal failure (CRF) patients do not have higher mortality following coronary artery bypass grafting (CABG) than non-HD dependent CRF patients.
Beril Akman, MD, and his colleagues at Baskent University in Ankara, Turkey, looked at 24-month survival following elective CABG surgery among 47 HD-dependent CRF patients (group I) and 55 CRF patients who did not require HD (group II). After the first post-op year, 13 patients in group I (27.7%) and nine in group II (16.4%) died, a nonsignificant difference. Cumulative survival at 24 months was 72.3% in group I and 83.6% in group II, Dr. Akman reported here at the Annual Dialysis Conference.
Infection increased the risk of death by 4.4 times in group I and 9.4 times in group II, a significant difference. As to why infection was a greater risk factor for death in group II, Dr. Akman explained that group I patients probably were followed more closely during their thrice-weekly dialysis sessions, so infections were diagnosed and treated earlier.
Infection occurred in five patients in group I (10.6%) and 10 in group II (18.2%), but nevertheless the difference in infection rate between the groups was not statistically significant. The mean age of group I was younger than that of group II (56.6 vs. 63.2 years). Group I also had significantly lower systolic (122.1 vs. 137.4 mm Hg) and diastolic pressure (71.8 vs. 79.7 mm Hg) than group II, and lower BMI (24.7 vs. 26.4 kg/m2). None of the preoperative risk factors (age, BMI, ejection fraction, smoking, hypertension, hyperlipidemia, diabetes mellitus, and previous MI) affected mortality.
Technical improvement in dialysis has increased survival and quality of life in HD patients, Dr. Akman said. Cardiovascular morbidity and mortality remain high, but if patients are prepared appropriately for CABG and closely followed postoperatively, survival is not different from that of the non-HD dependent CRF patient. Timely CABG can further increase quality of life and survival in HD patients, as well as decrease complications during HD, he added. “So life still exists after the start of HD therapy, and HD patients deserve the best care like other people.”