Kidney Research and Clinical Practice  
Outcomes of open heart surgery in patients with endstage renal disease
Jung Hwa Park1 , Jeong-Hoon Lim1 , Kyung Hee Lee1 , Hee-Yeon Jung1 , Ji-Young Choi1 , Jang-Hee Cho1 , Chan-Duck Kim1 , Yong-Lim Kim1 , Hanna Jung2 , Gun Jik Kim2 , Sun-Hee Park1
1Division of Nephrology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea 2Department of Thoracic and Cardiovascular Surgery, Kyungpook National University School of Medicine, Daegu, Korea
Correspondence to: Sun-Hee Park
Division of Nephrology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea.
E-mail: sh-park@ knu.ac.kr
Received: October 2, 2018; Revised: March 15, 2019; Accepted: March 19, 2019; Published online: April 24, 2019.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: 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.
Methods: 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.
Results: 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%, P = 0.005) and more overall complications (65.8% vs. 25.6%, P = 0.000). 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; P = 0.029) and in-hospital death risk (AOR, 14.7; P = 0.033), the durations of postoperative hospitalization (AOR, 4.6; P = 0.034), CRRT (AOR 36.8; P = 0.004), and ventilator use (AOR, 7.6; P = 0.022) were significantly increased in the dialysis group.
Conclusions: 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.
Keywords: Cardiovascular disease, Dialysis, Renal insufficiency, Thoracic surgery


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