Park Jung Hwa, Lim Jeong-Hoon, Lee Kyung Hee, Jung Hee-Yeon, Choi Ji-Young, Cho Jang-Hee, Kim Chan-Duck, Kim Yong-Lim, Jung Hanna, Kim Gun Jik, Park Sun-Hee
Division of Nephrology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Department of Thoracic and Cardiovascular Surgery, Kyungpook National University School of Medicine, Daegu, Korea.
Kidney Res Clin Pract. 2019 Sep 30;38(3):399-406. doi: 10.23876/j.krcp.18.0123.
Cardiovascular diseases of chronic dialysis patients are often undertreated because of their higher surgical risk. This study aimed to assess mortality and morbidity after open heart surgery in chronic dialysis patients compared to those with normal renal function and identify risk factors for postoperative outcomes.
We retrospectively analyzed 2,432 patients who underwent open heart surgery from 2002 to 2017 and collected data from 116 patients (38 patients on dialysis and 78 age-, sex-, and diabetes mellitus status-matched control patients with normal kidney function). We assessed comorbidities, New York Heart Association (NYHA) class, laboratory data, surgical methods, and postoperative outcomes.
The dialysis group had more comorbidities, higher NYHA classes, and greater need for urgent surgeries compared to the control group. They exhibited significantly higher postoperative mortality (18.4% vs. 2.6%, = 0.005) and more overall complications (65.8% vs. 25.6%, P < 0.001). Dialysis itself significantly increased relative risk for inhospital mortality after adjustment. EuroSCORE II was not as useful as in the general population. Multivariate logistic regression analysis demonstrated that total (adjusted odds ratio [AOR], 10.7; = 0.029) and in-hospital death risk (AOR, 14.7; = 0.033), the durations of postoperative hospitalization (AOR, 4.6; = 0.034), CRRT (AOR 36.8; = 0.004), and ventilator use (AOR, 7.6; = 0.022) were significantly increased in the dialysis group.
The dialysis group exhibited a higher risk for mortality and overcall complications after open heart surgery compared to the patients with normal renal function. Therefore, the benefit of surgical treatment must be balanced against potential risks.
慢性透析患者的心血管疾病往往因手术风险较高而治疗不足。本研究旨在评估慢性透析患者与肾功能正常患者接受心脏直视手术后的死亡率和发病率，并确定术后结局的危险因素。
我们回顾性分析了2002年至2017年接受心脏直视手术的2432例患者，并收集了116例患者的数据（38例透析患者以及78例年龄、性别和糖尿病状态相匹配的肾功能正常的对照患者）。我们评估了合并症、纽约心脏协会（NYHA）分级、实验室数据、手术方法和术后结局。
与对照组相比，透析组有更多的合并症、更高的NYHA分级，且更需要急诊手术。他们的术后死亡率显著更高（18.4%对2.6%，P = 0.005），总体并发症更多（65.8%对25.6%，P < 0.001）。调整后，透析本身显著增加了住院死亡率的相对风险。欧洲心脏手术风险评估系统II（EuroSCORE II）在该人群中不如在普通人群中有用。多因素逻辑回归分析表明，透析组的总体（调整优势比[AOR]，10.7；P = 0.029）和住院死亡风险（AOR，14.7；P = 0.033）、术后住院时间（AOR，4.6；P = 0.034）、连续性肾脏替代治疗（CRRT，AOR 36.8；P = 0.004）和呼吸机使用（AOR，7.6；P = 0.022）均显著增加。
与肾功能正常的患者相比，透析组在心脏直视手术后的死亡风险和总体并发症风险更高。因此，必须在手术治疗的益处与潜在风险之间取得平衡。
