Comparison of long-term prognosis between coronary artery disease and peripheral artery disease in haemodialysis and non-dialysis patients

Abstract Background Patients on hemodialysis (HD) have been consistently recognized as a population with a high risk for cardiovascular diseases. However, it has not been clear which vascular disease had more impact on clinical prognosis. The aim of this study was to compare coronary artery disease (CAD) and peripheral artery disease (PAD) among HD and non-HD patients undergoing coronary artery bypass graft (CABG) and lower extremity bypass (LEB) surgery. Methods A total of consecutive 1,867 patients who initially and successfully underwent cardiovascular bypass surgery (242 CABG and 620 LEB in HD patients, 604 CABG and 401 LEB in non-HD patients) were enrolled in this study. They were followed up for up to 10-year. The primary endpoint was all-cause mortality. Results Cumulative mortality rates for 10-year were 15.6%, 21.8%, 38.7% and 58.9% after CABG in non-HD patients, LEB in non-HD patients, CABG in HD patients and LEB in HD patients, respectively (Figure). HD patients consistently had higher risk of mortality after cardiovascular bypass surgery compared to non-HD patients [adjusted hazard ratio (aHR) 3.04, 95% confidence interval (CI) 2.21-4.36, p<0.0001]. Similar results were observed after CABG and LEB in both, respectively (aHR 2.50, 95%CI 1.75-3.61, p<0.0001 for CABG and aHR 3.07, 95%CI 3.07, 95%CI 2.21-4.36, p<0.0001). Also, patients with LED tended to have higher risk of mortality compared to those with CABG (aHR 1.25, 95%CI 1.0.99-1.57, p=0.057) in entire cohort. However, the risk of mortality was significantly higher after LED than CABG in HD patients (aHR 1.34, 95%CI 1.02-1.81, p=0.042) but not in non-HD patients (aHR 1.00, 95%CI 0.67-1.49), p=0.98). In addition, HD patients with LEB had markedly higher risk of mortality compared to non-HD patients with CABG (aHR 3.50, 95%CI 2.62-4.74, p<0.0001). Conclusion Long-term prognosis was consistently poorer after cardiovascular surgery regardless of CABG or LEB in HD patients than in non-HD patients. The risk of mortality was also significantly higher after LEB than CABG in HD patients but not non-HD patients, and HD patients with LEB was considered to have the highest mortality risk in the study. Thus, PAD might be at more advanced atherosclerotic status than CAD in this high-risk population.