Coronary surgery in patients requiring chronic hemodialysis

Background: In uremic patients coronary surgery and the entire perioperative management is demanding. Methods: We analyzed retrospectively data from all patients requiring chronic hemodialysis who underwent coronary artery bypass grafting (CABG) between January 1 2001 and December 31 2004 at the Deutsches Herzzentrum Berlin and compared them to those of a randomized nonuremic control group (n = 68), which consisted of patients who underwent CABG during the same period. Results: During the study period 6315 patients underwent coronary artery bypass grafting at the Deutsches Herzzentrum Berlin. Among these patients, we identified 71 chronic dialysis patients (1.12%). Among dialysis patients, we recorded a perioperative mortality of 5.6%. One-year survival rate was 87.7% among uremic patients and 91.0% in the control group; the corresponding 4-year survival rates were 56.7 and 88.0%, respectively. The incidence of peripheral artery disease was significantly higher in the dialysis group. Uremic patients showed significantly lower hemoglobin serum levels at the time of admission compared to the control group (11.4 +/- 1.62 vs. 13.3 +/- 1.81 mg/dl). These patients received significantly higher numbers of blood transfusions (6.7 +/- 5.6 vs. 2.75 +/- 3.8), and platelet transfusions. Conclusion: Our preliminary study indicates that coronary surgery can be performed with acceptable midterm results when the specific requirements of this patient group are taken into account. Copyright (c) 2005 S. Karger AG, Basel.