Outcome of dialysis patients submitted to coronary revascularization

Cardiovascular disease accounts for almost half of the total mortality in p atients with end stage renal disease (ESRD). It has recently been debated w hether coronary revascularization has the same rate of risks and successes in this cohort of patients compared to patients without renal disease. Since 1991, 17 dialysis patients were submited to coronary revascularizatio n in our center. Seven patients were following peritoneal, 10 hemodialytic treatment. Four patients were submitted to percutaneous transluminal corona ry angioplasty (PTCA) and 13 to surgical revascularization (CABG). In 2 patients the coronary lesion was unique, in the others stenosis of mul tiple vessels were found. Six patients were diabetic. The mean age at the onset of the coronary artery disease (CAD) was 57.17+/- 11.6 years. The mean time elapsed from the onset of the CAD and the perform ance of the PTCA or CABG was 30.1 +/- 35.4 months. The mean time from begin ning of dialysis treatment to revascularization was 48.2+/-39.6 months. Mea n hemoglobin values were 9.7+/-1g/dL, mean phosphorus values were 5.2 +/- 8 .7 mg/dL, mean cholesterol values were 211 +/- 49.5 mg/dL. The procedure was technically successful in all patients. Mean survival was 25.09 +/- 28.12 months. Twelve patients died, 5 of whom within one month. Survival at one month was 70.5%, at 6 months 58.8%, at one year 52.9%, at 2 years 47%. There was neither significant difference patients submitted to PTCA and those submitted to CABG, nor between diabetic and non-diabetic pat ients. In conclusion, coronary revascularization in our experience is a high risk procedure in dialysis patients. The reasons for this could be the severe ge neral conditions of these patients affected with diffuse vasculopathy and t he long time elapsed since the onset of the ischemic cardiopathy. Thus, our results could suggest the opportunity of performing earlier screening of c oronary situation and revascularization treatment in CAD dialysis patients.