Outcomes after cardiac surgeries in patients with chronic kidney disease on hemodialysis

Title: Outcomes after cardiac surgeries in patients with chronic kidney disease on hemodialysis. The aim: to evaluate outcomes after cardiac surgeries in patients with chronic kidney disease on hemodialysis and their interactions with preoperative factors. The objectives: 1) to identify the incidence of complications after cardiac surgeries in patients with chronic kidney disease on hemodialysis; 2) to compare the outcomes after cardiac surgeries between genders; 3) to compare the outcomes after different cardiac surgeries types; 4) to identify prognostic factors of mortality after cardiac surgeries in patients with chronic kidney disease on hemodialysis; 5) to compare results of this study with literature data. Methods: data of 43 patients with chronic kidney disease on hemodialysis undergoing cardiac surgery from 2008 to 2017 in the department of Cardiac surgery, Lithuanian University of Health Sciences, were reviewed retrospectively. We compared results between different cardiac surgeries types, genders, survivors and dead patients groups. Results: hospital mortality was 20,9 % (n=9) and depended on the shock (p=0,046) and gastrointestinal complications (p=0,040). Most common complication was arrythmia (53,5 %, n=23), more rarely – shock (34,9 %, n=15), pneumonia (25,6 %, n=11), delirium (11,6 %, n=5). Myocardial infarction was not detected in any of the cases. Resternotomy due to bleeding or tamponade has been performed in 4,7 % of patients (n=2). Pneumonia was statistically more common in men (p=0,008). There were no statistically significant differences comparing the rate of complications between the different types of operations. A history of stroke was more common in group of patients who underwent an urgent surgery. Prognostic factors of mortality were hypertensive nephropathy, reintubation and shock after surgery. Conclusions: arrythmia, shock, pneumonia, delirium were the most common complications after cardiac surgery in patients with chronic kidney disease on hemodialysis. Death reported in 20,9 % of patients. Pneumonia was more common in men. Prognostic factors of mortality were hypertensive nephropathy, reintubation and shock after surgery. Recommendations: there is enough data confirming that blood cardioplegia provides better myocardial protection than crystalloid cardioplegia, thus we believe that patients on hemodialysis may be more likely to benefit from this type of cardioplegia