Coronary artery bypass grafting in dialysis patients: a propensity score-matched analysis.

Abstract

Background: Patients undergoing dialysis treatment have long been recognized as having an elevated risk of developing coronary artery disease necessitating coronary artery bypass grafting (CABG). However, the prognostic implications of CABG in dialysis-dependent patients remain underexplored. This study aimed to comprehensively assess both short- and long-term outcomes in dialysis-dependent patients undergoing CABG.

Methods: In this retrospective analysis, we meticulously matched 55 dialysis-dependent patients with 55 non-dialysis patients, controlling for baseline characteristics including age, sex, etiology, and date of surgery. All patients underwent CABG treatment at our institution between January 2014 and June 2022. We conducted a comparative analysis of postoperative complications and survival rates between the two groups.

Results: Our findings revealed that the dialysis-dependent group exhibited a significantly higher incidence of postoperative complications compared to the non-dialysis group (92.7% vs. 61.8%; p < 0.001). Furthermore, the 5-year survival rates were notably diminished among dialysis patients relative to their non-dialysis counterparts (46.2 ± 7.9% vs. 58.2 ± 12.1%, p = 0.045). Consistently, dialysis patients exhibited decreased 5-year cardiac-event-free rates in contrast to non-dialysis patients (31.6 ± 7.6% vs. 58.8 ± 11.3%, p = 0.041). Predictably, several baseline parameters were identified as significant risk factors contributing to adverse outcomes among dialysis patients, including a history of smoking, diabetes mellitus, congestive heart failure upon admission, and the requirement for intraoperative concomitant surgery (p = 0.006, p = 0.043, p = 0.017, p = 0.003, respectively).

Conclusions: This study underscores the poorer prognosis associated with CABG treatment in dialysis-dependent patients. Notably, baseline factors such as a smoking history, diabetes mellitus, congestive heart failure upon admission, and the need for intraoperative concomitant surgery were all independently linked to increased mortality in this patient population.