Bassil Elias, Matta Milad, El Gharably Haytham, Harb Serge, Calle Juan, Arrigain Susana, Schold Jesse, Taliercio Jonathan, Mehdi Ali, Nakhoul Georges
Department of Kidney Medicine, Glickman Urological and Kidney Institute, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
Cardiovascular Medicine Department, Vanderbilt Vascular and Heart Institute, Vanderbilt University Medical Center, Nashville, Tennessee.
Kidney Med. 2023 Dec 9;6(3):100774. doi: 10.1016/j.xkme.2023.100774. eCollection 2024 Mar.
RATIONALE & OBJECTIVE: We sought to compare outcomes of patients receiving dialysis after cardiothoracic surgery on the basis of dialysis modality (intermittent hemodialysis [HD] vs peritoneal dialysis [PD]).
This was a retrospective analysis.
SETTING & PARTICIPANTS: In total, 590 patients with kidney failure receiving intermittent HD or PD undergoing coronary artery bypass graft and/or valvular cardiac surgery at Cleveland Clinic were included.
The patients received PD versus HD (intermittent or continuous).
Our primary outcomes were in-hospital and 30-day mortality. Secondary outcomes were length of stay, days in the intensive care unit, the number of intraoperative blood transfusions, postsurgical pericardial effusion, and sternal wound infection, and a composite of the following 4 in-hospital events: death, cardiac arrest, effusion, and sternal wound infection.
We used χ, Fisher exact, Wilcoxon rank sum, and tests, Kaplan-Meier survival, and plots for analysis.
Among the 590 patients undergoing cardiac surgery, 62 (11%) were receiving PD, and 528 (89%) were receiving intermittent HD. Notably, 30-day Kaplan-Meier survival was 95.7% (95% CI: 93.9-97.5) for HD and 98.2% (95% CI: 94.7-100) for PD ( = 0.30). In total, 75 patients receiving HD (14.2%) and 1 patient receiving PD (1.6%) had a composite of 4 in-hospital events (death, cardiac arrest, effusion, and sternal wound infection) ( = 0.005). Out of 62 patients receiving PD, 16 (26%) were converted to HD.
Retrospective analyses are prone to residual confounding. We lacked details about nutritional data. Intensive care unit length of stay was used as a surrogate for volume status control. Patients have been followed in a single health care system. The HD cohort outnumbered the PD cohort significantly.
When compared with PD, HD does not appear to improve outcomes of patients with kidney failure undergoing cardiothoracic surgery. Patients receiving PD had a lower incidence of a composite outcome of 4 in-hospital events (death, cardiac arrest, pericardial effusion, and sternal wound infections).
我们试图根据透析方式（间歇性血液透析[HD]与腹膜透析[PD]）比较心胸外科手术后接受透析的患者的预后。
这是一项回顾性分析。
总共纳入了590例在克利夫兰诊所接受间歇性HD或PD治疗且正在接受冠状动脉搭桥术和/或心脏瓣膜手术的肾衰竭患者。
患者接受PD与HD（间歇性或持续性）治疗。
我们的主要结局是住院期间和30天死亡率。次要结局包括住院时间、重症监护病房天数、术中输血次数、术后心包积液和胸骨伤口感染，以及以下4种住院事件的综合情况：死亡、心脏骤停、积液和胸骨伤口感染。
我们使用卡方检验、Fisher精确检验、Wilcoxon秩和检验以及t检验、Kaplan-Meier生存分析和绘图进行分析。
在590例接受心脏手术的患者中，62例（11%）接受PD治疗，528例（89%）接受间歇性HD治疗。值得注意的是，HD组30天的Kaplan-Meier生存率为95.7%（95%CI：93.9 - 97.5），PD组为98.2%（95%CI：94.7 - 100）（P = 0.30）。总共有75例接受HD治疗的患者（14.2%）和1例接受PD治疗的患者（1.6%）出现了4种住院事件的综合情况（死亡、心脏骤停、积液和胸骨伤口感染）（P = 0.005）。在62例接受PD治疗的患者中，有16例（26%）转为HD治疗。
回顾性分析容易存在残余混杂因素。我们缺乏营养数据的详细信息。重症监护病房住院时间被用作容量状态控制的替代指标。患者在单一医疗系统中接受随访。HD队列的人数显著多于PD队列。
与PD相比，HD似乎并不能改善接受心胸外科手术的肾衰竭患者的预后。接受PD治疗患者发生4种住院事件（死亡、心脏骤停、心包积液和胸骨伤口感染）综合结局的发生率较低。
