Borji Roghayeh, Ahmadi Seyyed Hossein, Barkhordari Khosrow, Meysami Ali Pasha, Karimi Abbas Ali, Mortazavi Seyedeh Hamideh, Dadlani Parinaaz, Ayatollah Zadeh Esfahani Farah, Khatami Seyyed Mohammad Reza
Internal Medicine Department, Imam Khomeini Hospital, Tehran, Iran.
Nephron. 2017;136(3):226-232. doi: 10.1159/000470854. Epub 2017 Apr 22.
BACKGROUND/AIMS: Coronary artery bypass grafting (CABG) is associated with an increased risk of morbidity and mortality in patients with pre-existing renal dysfunction. Numerous measures have been implemented to overcome this problem; however, no improvement in outcomes has been achieved. This study was aimed at investigating the effects of prophylactic dialysis on mortality and morbidity in these patients.
This randomized-controlled clinical trial enrolled 88 non-dialysis-dependent patients with chronic kidney disease awaiting CABG surgery. Thirty-nine randomly selected patients received dialysis 3 times prior to surgery, and 49 patients formed the control group. Kaplan-Meier analysis and Cox proportional-hazards models were used to identify factors associated with survival.
There was no significant difference in the development of morbidities between the groups (p = 0.413). A significant difference was evident in the average survival time (p = 0.037). Cox proportional-hazards models determined that the hazard ratio of death after surgery was 10.854-fold greater in non-dialysis patients than in patients who received dialysis (hazard ratio = 2).
Prophylactic dialysis prior to CABG decreases mortality, but does not affect morbidity, in patients with renal insufficiency.
背景/目的：冠状动脉旁路移植术（CABG）与已有肾功能不全患者的发病和死亡风险增加相关。已采取多种措施来克服这一问题；然而，结局并未得到改善。本研究旨在调查预防性透析对这些患者死亡率和发病率的影响。
这项随机对照临床试验纳入了88例等待CABG手术的非透析依赖型慢性肾病患者。39例随机选择的患者在手术前接受3次透析，49例患者组成对照组。采用Kaplan-Meier分析和Cox比例风险模型来确定与生存相关的因素。
两组之间发病率的发生无显著差异（p = 0.413）。平均生存时间有显著差异（p = 0.037）。Cox比例风险模型确定，非透析患者术后死亡的风险比接受透析的患者高10.854倍（风险比 = 2）。
对于肾功能不全患者，CABG术前进行预防性透析可降低死亡率，但不影响发病率。
