Effect of Prophylactic Dialysis on Morbidity and Mortality in Non-Dialysis-Dependent Patients after Coronary Artery Bypass Grafting: A Pilot Study

Abstract

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. Methods: 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. Results: 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). Conclusion: Prophylactic dialysis prior to CABG decreases mortality, but does not affect morbidity, in patients with renal insufficiency.

Prophylactic dialysis improves short-term clinical outcome in patients with non-dialysis-dependent chronic kidney disease undergoing cardiac surgery: a meta-analysis of randomized controlled trials

“…Overall, the quality of the included RCTs was moderate. Two of the researches reported the generation of random sequences, and the strategies for allocation concealment were reported in them [ 21 , 22 ]. It was impossible to blind surgeons and other clinicians in the operating room from noticing the presence of a dialysis device and blinded to the intervention allocation.…”

“…Compared to high-dose diuretics, it can suppress neurohormonal activation and greatly shorten the duration of hospitalization [ 24 ]. Besides, hemodialysis could improve ventricular function [ 19 , 22 ]. As a result, prophylactic dialysis can improve clinical outcomes and decrease adverse events significantly, especially for those with previous renal dysfunction.…”

“…Furthermore, there is a high incidence of delayed extubation because of pulmonary congestion caused by impaired water clearance [ 19 ] and delayed anesthetic drug metabolism [ 19 ], which may contribute to a higher incidence of pulmonary complications. Dialysis could also favorably affect contractility, the most likely mechanisms include the removal of the uremic toxins, increases of plasma ionized calcium and increase of bicarbonate concentrations [ 19 , 22 ]. In conclusion, prophylactic dialysis can improve clinical outcomes of non-dialysis-dependent CKD patients undergoing cardiac surgery, and the most likely cause is the cardio-renal protection of dialysis.…”

“…1. Finally, 4 RCTs [19][20][21][22] were included in the meta-analysis with a total of 395 patients (dialysis group, n = 188; control group, n = 207) (Table 1). All types of cardiac surgery in these studies are CABG, and all types of intervention of which are conventional dialysis.…”