The role of elective perioperative dialysis in nondialysis renal failure patients.

Abstract

Patients with renal insufficiency represent a difficult group. They show an increased morbidity and mortality after heart surgery. Nondialysis chronic kidney disease patients show higher mortality than patients receiving chronic dialysis. Their management is not standardized. This study was undertaken to determine whether elective perioperative dialysis in these patients improved outcomes. A retrospective review of records of nondialysis chronic kidney disease patients was carried out. Patients who were not dialyzed before surgery (group A, n = 28) were compared with a propensity-matched group of patients (group B, n = 28) who received elective dialysis preoperatively for their baseline characteristics and outcomes of their heart surgery. Patients who received elective dialysis in the perioperative period (group B) showed fewer neurologic complications (p = 0.004), shorter postoperative length of stay (p = 0.053), fewer gastrointestinal complications (p = 0.051), and fewer major adverse events (p = 0.013). Multiorgan failure and discharge to an extended care facility were also less frequent in group B, although this did not reach statistical significance. Nondialysis renal failure patients, particularly those with higher creatinine concentrations, may benefit from elective perioperative dialysis in terms of decreased rates of complications and shorter postoperative length of stay.