Peritoneal Dialysis after Cardiac Surgery

As many are aware, there is some debate whether patients receiving peritoneal dialysis should be converted temporarily to hemodialysis around the time of cardiac surgery.
 
In a recent publication in Peritoneal Dialysis International, observational data suggests that PD patients do better than HD patients after cardiac surgery.  To be clear, this paper does not address the question of whether switching PD patients to HD is a superior strategy to continuing PD around the time of surgery.  However, the findings are reassuring in that patients on PD tend to do well compared to HD patients.  It should be noted that the effort to match patients for comorbidity limits bias in favour of PD.
  
Comparing Cardiac Surgery in Peritoneal Dialysis and Hemodialysis Patients:
Perioperative Outcomes and Two-Year Survival
Victoria A. Kumar, Shubha Ananthakrishnan, Scott A. Rasgon, Eric Yan, Raoul
Burchette, and Karen Dewar
Perit Dial Int 2012;32 137-141
http://www.pdiconnect.com/cgi/content/abstract/32/2/137?etoc
 
Comparing Cardiac Surgery in Peritoneal Dialysis and Hemodialysis Patients: Perioperative Outcomes and Two-Year Survival

♦ Background: We sought to compare perioperative outcomes and 2-year survival in a cohort of peritoneal dialysis (PD) patients compared with matched hemodialysis (HD) patients who underwent cardiothoracic surgery at our institution.
♦ Methods: We obtained a list of all dialysis-dependent patients who underwent cardiac surgery (coronary artery bypass grafting, valve replacement, or both) at our center between 1994 and 2008. All patients undergoing PD at the time of surgery were included in our analysis. Two HD patients matched for age, diabetes status, and Charleston comorbidity score were obtained for each PD patient.
♦ Results: The analysis included 36 PD patients and 72 HD patients. Mean age, sex, diabetes status, cardiac unit stay, hospital stay, and operative mortality did not differ by dialysis modality. The incidence of 1 or more postoperative complications (infection, prolonged intubation, death) was higher for HD patients (50% vs. 28% for PD patients, p = 0.046). After surgery, 2 PD patients required conversion to HD. The 2-year survival was 69% for PD patients and 66% for HD patients (p = 0.73).
♦ Conclusions: Our findings suggest that, compared with HD patients, PD patients who require cardiac surgery do not experience more early complications or a lesser 2-year survival and that 2-year survival for dialysis patients after cardiac surgery is acceptable.

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