Coronary Artery Bypass Grafting in Patients on Chronic Hemodialysis: Diabetic Nephropathy Versus Nondiabetic Nephropathy

Abstract

Patients with both end-stage renal disease and diabetes mellitus carry an increased risk of coronary atherosclerosis. This study was performed to evaluate the perioperative and remote outcome of diabetic nephropathy patients on hemodialysis undergoing coronary artery bypass grafting (CABG). We retrospectively analyzed the results of CABG performed between September 1, 1993 and August 31, 2001. Preoperative, perioperative, and follow-up data of patients with hemodialysis primarily due to diabetic nephropathy (Group D, n = 31, 22 males and 9 females with a mean age of 60.1 +/- 6.6) were collected and compared to patients with hemodialysis primarily due to nondiabetic nephropathy (group N, n = 21, 17 males and 4 females with a mean age of 60.9 +/- 11.2). Preoperative risk factors between the 2 groups were not significantly different. The mean number of distal anastomoses was 2.5 +/- 1.2 in Group D and 2.5 +/- 1.0 in Group N (p = not significant [NS]). All patients received at least 1 internal mammary artery graft. There was 1 in-hospital death in each group. Postoperative recovery, mortality, and morbidity were not significantly different between the two groups. At the mean follow-up of 2.7 years, the actuarial 3 year survival rate was 72.8% in Group D and 78.7% in Group N (p = NS). The actuarial 3 year cardiac event-free rate was 79.7% in Group D and 74.7% in Group N (p = NS). CABG for hemodialysis patients can be performed with acceptable risks. Diabetic nephropathy has no impact on early or remote patient outcomes among patients on hemodialysis.

Value of Diabetes as an Independent Predictor of Death in Subjects with End-Stage Renal Disease

“…Hirose et al [14] could not show any survival difference of diabetic and nondiabetic ESRD patients in their study after coronary bypass surgery (CABG). Other studies confirmed these results in ESRD patients with and without CAD and in ESRD patients with CABG [14,15].…”

“…Hirose et al [14] could not show any survival difference of diabetic and nondiabetic ESRD patients in their study after coronary bypass surgery (CABG). Other studies confirmed these results in ESRD patients with and without CAD and in ESRD patients with CABG [14,15]. Aoki et al [16] showed that not diabetes but renal insufficiency is an independent predictor of mortality in diabetic and nondiabetic ESRD patients after percutaneous coronary intervention: when ESRD patients with CAD were revascularized, patients with and without diabetes showed no difference in survival.…”

Influence of hemodialysis duration on mid-term clinical outcomes in hemodialysis patients with coronary artery disease after drug-eluting stent implantation

“…Feuvre et al [39] suggested that cardiac death and non-fatal MI at 4 years after coronary angioplasty were significantly higher in diabetics on dialysis than in non-diabetics not on dialysis, and Sardi et al [40] demonstrated that diabetic patients had a significantly higher incidence of 1-year TLR compared to non-diabetic patients. On the other hand, there have been some studies that suggested no significant differences in cardiovascular outcomes in HD patients with and without DM after PCI or CABG [41][42][43]. However, all these studies were retrospective and non-randomized; thus, prospective and randomized trials would be suitable to confirm this issue.…”

Is Diabetic Nephropathy a Predicted Risk Factor? Kaplan-Meier and Multivariate Analysis of Confounding Risk Factors in Off-Pump Coronary Artery Bypass Grafting for Chronic Dialysis Patients

“…Several recent reports on survival of patients with chronic dialysis after CABG 4,[15][16][17][18][19][20][21][22][23][24][25][26] have demonstrates the operation can be performed with an acceptable mortality and morbidity for dialysis patients. 16,17,19,23,24,26 Herzog et al reported that dialysis patients have better long-term survival after CABG surgery than after percutaneous coronary intervention, especially diabetic patients.…”

“…16,17,19,23,24,26 Herzog et al reported that dialysis patients have better long-term survival after CABG surgery than after percutaneous coronary intervention, especially diabetic patients. 23 In Japan, OPCAB is currently the most common strategy for patients with coronary artery disease.…”