Coronary artery bypass grafting in patients on chronic hemodialysis: surgical outcome in diabetic nephropathy versus nondiabetic nephropathy patients

Background. The presence of diabetes mellitus adversely affects the late su rvival of patients undergoing coronary artery bypass grafting (CABG). The p urpose of this study is to clarify the role of diabetic nephropathy on outc omes of a group of patients on chronic hemodialysis undergoing CABG. Methods. Between April 1984 and July 1999, 45 patients on chronic hemodialy sis underwent CABG. Forty-three had conventional CABG and 2 had off-pump CA BG. There were 37 males and 8 females, and the mean age was 57 years (43 to 76 years). Twenty-one patients had diabetic nephropathy (group D) and 24 h ad nondiabetic nephropathy (group ND). Early and late results were determin ed in both groups. Results. Early outcome was not significantly different between the groups. There was no hospital mortality, stroke, or requirement for prolonged mecha nical ventilation (> 24 hours) in either group. No patients in group D, and only 1 (4.2%) in group ND had low cardiac output syndrome. The difference in the incidence of arrhythmias (23.8% in group D and 25% in group ND), wou nd infections (9.5% in group D and 8.3% in group ND), and delayed tamponade (5% in group D and 12.5% in group ND) was not statistically significant; H owever, late results differed significantly between the two groups. Actuari al survival (Kaplan-Meier);at 5 and 9 years was 22.9% and 11.5% in group D and 89.1% and 45.7% in group ND (p = 0.01), respectively. Similarly, the ca rdiac event-free rate at the same intervals was 50.4% and 0% for group D an d 100% and 65.8% for group ND (p = 0.001), respectively. Conclusions. Using present technology, CABG can be done in patients on chro nic hemodialysis with acceptable early mortality and morbidity. Late result s in patients with diabetic nephropathy on hemodialysis are not as I favora ble as their nondiabetic cohort. (C) 2001 by The Society of Thoracic Surgeo ns.