RATES AND OUTCOMES OF CARDIAC SURGERY FOR PEOPLE RECEIVING LONG TERM DIALYSIS OR KIDNEY TRANSPLANTATION IN AUSTRALIA

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https://storage.unitedwebnetwork.com/files/1099/b5c0d9a75bca6d1cdab7e0335a5521ff.pdf

Abstract Title

First Name *

Stephen

Last Name *

McDonald

Co-author 1

Dominic Keuskamp Dominic@anzdata.org.au SA Health and Medical Research Institute ANZDATA Registry Adelaide

Co-author 2

Christopher Davies chris2@anzdata.org.au SA Health and Medical Research Institute ANZDATA Registry Adelaide

Co-author 3

Julian Smith julian.smith@monash.edu Monash University Cardiac Surgery Melbourne

Co-author 4

Robert Baker Rob.Baker@sa.gov.au Flinders University Cardiac Surgery Adelaide

Co-author 5

Christopher Reid christopher.reid@curtin.edu.au Monash University Public Health Melbourne

Co-author 6

Jenni Williams-Spence jenni.williams-spence@monash.edu Monash University Public Health Melbourne

Co-author 7

Lavinia Tran lavinia.tran@monash.edu Monash University Public Health Melbourne

Co-author 8

Kevan Polkinghorne kevan.polkinghorne@monash.edu Monash University Nephrology Melbourne

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Rates of coronary artery disease and cardiac valve disorders are higher among people with kidney failure (KF) receiving dialysis or with a kidney transplant. Cardiac surgery (CS - coronary artery bypass grafting [CABG] and valve replacement surgery) are important treatment options for these, but may carry substantial risks. Utilising data linkage of two registries with national coverage, we examined rates and outcomes of CS among patients receiving long term dialysis or with a kidney transplant.

Methods

Data were linked probabilistically between the Australia & New Zealand Dialysis & Transplant Registry and the Australian & New Zealand Society of Cardiac & Thoracic Surgeons Cardiac Surgery Database. Thirty-day mortality adjusted for risk factors was compared for 3 groups based on status at time of surgery (dialysis / kidney transplant / non-kidney failure [KF]) using multiple logistic regression. The study population included all eligible CS in Australia from 2001-2019.

Results

	Dialysis	Transplant	Non-KF
Number	1639 (74% male)	353 (75% male)	150741 (73% male)
Age (median (IQR); years)	63 (55-71)	64 (55-69)	68 (59-71)
Diabetes (%)	58	44	29
Procedure type (Isolated CABG / Isolated valve / combined)	955/301/244	131/98/55	80606/30754/15298
Unadjusted 30 day mortality [95% CI]	6.5 [5.3-7.8]%	4.5 [2.6-7.3]%	2.2 [2.1-2.3]%

Demographics are shown in the Table. Crude 30-day mortality was highest among the dialysis group then the transplant and non-KF groups. Mortality progressively improved over time. Adjusted for procedure type and other comorbidities, excess mortality persisted for the KF groups. The odds ratio for 30 day mortality for CS in the dialysis group was 3.4 [2.7-4.2] and for the transplant group was 2.4 [1.4-4.2]. Adjusted analyses showed increased risk of mortality were seen for valve replacement (vs CABG), urgent surgery, comorbidities and those with greater dialysis vintage. Mortality at 24 months was 32 [29-35]% for the dialysis group and 16 [12-20]% for the transplant group.

Conclusions

Among KF patients requiring CS, early mortality rates are substantially increased, especially when other comorbidities are present or surgery is urgent. While the risks of not operating are not known for these cohort, these data will inform and support careful consideration of the risks of cardiac surgery in this group. This abstract was also presented at the American Society of Nephrology congress in November 2023.

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