Jimmy T Efird1, Wesley T O'Neal2, Catherine A Gouge2, Linda C Kindell2, Whitney L Kennedy2, Paul Bolin3, Jason B O'Neal4, Curtis A Anderson2, Evelio Rodriguez5, T Bruce Ferguson2, W Randolph Chitwood2, Alan P Kypson2. 1. Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA ; Center for Health Disparity Research, East Carolina University, USA. 2. Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA. 3. Department of Internal of Medicine, Division of Nephrology and Hypertension. Brody School of Medicine, East Carolina University, Greenville, NC, USA. 4. Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA. 5. Saint Thomas Heart Hospital, Nashville, TN, USA.
Abstract
BACKGROUND: Cardiovascular disease is the leading cause of morbidity and mortality in patients on hemodialysis. To our knowledge, no studies have examined long-term outcomes of hemodialysis patients following coronary artery bypass grafting (CABG) in a predominately rural, low-income, and racially dichotomous population. METHODS: Long-term survival of hemodialysis patients undergoing non-emergent, isolated CABG was compared with non-hemodialysis patients. Survival probabilities were computed using the Kaplan-Meier product limit method and stratified by hemodialysis. Hazard ratios (HR) and 95% confidence intervals (95%CI) were computed using a Cox regression model. RESULTS: Hemodialysis patients (n=220) had shorter long-term survival than non-hemodialysis patients (median survival=3.3 versus 14 years, p<0.0001). The survival difference remained statistically significant after adjusting for clinically relevant variables (HR=5.2, 95%CI=4.4-6.2). CONCLUSION: Hemodialysis patients had significantly shorter long-term survival compared with non-hemodialysis patients after CABG. Further research is needed to address the cost and policy implications of our findings, especially among priority populations.
BACKGROUND:Cardiovascular disease is the leading cause of morbidity and mortality in patients on hemodialysis. To our knowledge, no studies have examined long-term outcomes of hemodialysis patients following coronary artery bypass grafting (CABG) in a predominately rural, low-income, and racially dichotomous population. METHODS: Long-term survival of hemodialysis patients undergoing non-emergent, isolated CABG was compared with non-hemodialysis patients. Survival probabilities were computed using the Kaplan-Meier product limit method and stratified by hemodialysis. Hazard ratios (HR) and 95% confidence intervals (95%CI) were computed using a Cox regression model. RESULTS: Hemodialysis patients (n=220) had shorter long-term survival than non-hemodialysis patients (median survival=3.3 versus 14 years, p<0.0001). The survival difference remained statistically significant after adjusting for clinically relevant variables (HR=5.2, 95%CI=4.4-6.2). CONCLUSION: Hemodialysis patients had significantly shorter long-term survival compared with non-hemodialysis patients after CABG. Further research is needed to address the cost and policy implications of our findings, especially among priority populations.
Authors: Luis Gruberg; Prithvi Rai; Gary S Mintz; Daniel Canos; Ellen Pinnow; Lowell F Satler; Augusto D Pichard; Kenneth M Kent; Ron Waksman; Joseph Lindsay; Neil J Weissman Journal: Am J Cardiol Date: 2005-10-01 Impact factor: 2.778
Authors: Bryon J Boulton; Patrick Kilgo; Robert A Guyton; John D Puskas; Omar M Lattouf; Edward P Chen; Willam A Cooper; J David Vega; Michael E Halkos; Vinod H Thourani Journal: Ann Thorac Surg Date: 2011-06-25 Impact factor: 4.330
Authors: Martha L Daviglus; Kiang Liu; Amber Pirzada; Lijing L Yan; Daniel B Garside; Philip Greenland; Larry M Manheim; Alan R Dyer; Renwei Wang; James Lubitz; Willard G Manning; James F Fries; Jeremiah Stamler Journal: Arch Intern Med Date: 2005-05-09
Authors: J Y Liu; N J Birkmeyer; J H Sanders; J R Morton; H F Henriques; S J Lahey; R W Dow; C Maloney; A W DiScipio; R Clough; B J Leavitt; G T O'Connor Journal: Circulation Date: 2000-12-12 Impact factor: 29.690
Authors: E L Hannan; M van Ryn; J Burke; D Stone; D Kumar; D Arani; W Pierce; S Rafii; T A Sanborn; S Sharma; J Slater; B A DeBuono Journal: Med Care Date: 1999-01 Impact factor: 2.983
Authors: Michel B Chonchol; Victor Aboyans; Philippe Lacroix; Gerard Smits; Tomas Berl; Marc Laskar Journal: J Thorac Cardiovasc Surg Date: 2007-09 Impact factor: 5.209
Authors: Margreet R de Vries; Karin H Simons; J Wouter Jukema; Jerry Braun; Paul H A Quax Journal: Nat Rev Cardiol Date: 2016-05-19 Impact factor: 32.419
Authors: Jimmy T Efird; William F Griffin; Preeti Gudimella; Wesley T O'Neal; Stephen W Davies; Patricia B Crane; Ethan J Anderson; Linda C Kindell; Hope Landrine; Jason B O'Neal; Hazaim Alwair; Alan P Kypson; Wiley L Nifong; W Randolph Chitwood Journal: Ann Cardiothorac Surg Date: 2015-09
Authors: Jimmy T Efird; Wesley T O'Neal; William F Griffin; Ethan J Anderson; Stephen W Davies; Hope Landrine; Jason B O'Neal; Kristin Y Shiue; Linda C Kindell; T Bruce Ferguson; W Randolph Chitwood; Alan P Kypson Journal: Medicine (Baltimore) Date: 2015-02 Impact factor: 1.889
Authors: Jimmy T Efird; Wesley T O'Neal; Paul Bolin; Stephen W Davies; Jason B O'Neal; Curtis A Anderson; T Bruce Ferguson; W Randolph Chitwood; Alan P Kypson Journal: Int J Environ Res Public Health Date: 2013-09-06 Impact factor: 3.390
Authors: Jimmy T Efird; Wesley T O'Neal; Stephen W Davies; Jason B O'Neal; Linda C Kindell; Curtis A Anderson; W Randolph Chitwood; T Bruce Ferguson; Alan P Kypson Journal: Int J Environ Res Public Health Date: 2014-07-21 Impact factor: 3.390