Effect of Dialysis Modality on Mortality and Complications in Cardiovascular Surgery

Key Points Maintaining peritoneal dialysis during the perioperative period may confer benefits over hemodialysis, including lower hospital charges and improved patient outcomes. Peritoneal dialysis is associated with lower in-hospital mortality compared with hemodialysis in patients undergoing cardiac surgery. Background Patients receiving maintenance dialysis face high mortality and complication rates after cardiovascular (CV) surgery. With the growing utilization of peritoneal dialysis (PD), it is important to understand the effect of modality (PD versus center-based hemodialysis) on outcomes after CV surgery. Methods This retrospective cohort study used data from the National Inpatient Sample (2016–2020) to compare outcomes of PD and hemodialysis patients undergoing coronary artery bypass grafting and surgical valve procedures. Multivariable logistic regression, negative binomial regression, and linear regression models were used, adjusting for demographic factors, comorbidities, and hospital characteristics. The primary outcome was in-hospital mortality, and secondary outcomes included prolonged ventilation, length of stay, and hospital charges. Results A total of 30,155 patients were included in the study, with 28,015 (92.9%) receiving hemodialysis and 2140 (7.1%) receiving PD. Compared with hemodialysis, PD was associated with lower in-hospital mortality (odds ratio, 0.61; 95% confidence interval [CI], 0.38 to 0.97), reduced prolonged ventilation (odds ratio, 0.51; 95% CI, 0.32 to 0.81), shorter length of stay (incidence rate ratio, 0.85; 95% CI, 0.80 to 0.91), and decreased hospital charges (mean difference, −$87,172 USD; 95% CI, −$113,523 to −$60,820) compared with hemodialysis. Among PD patients, postoperative transition to hemodialysis was associated with worse outcomes. Conclusions Maintaining PD during the perioperative period may confer benefits over hemodialysis, including lower hospital charges and improved patient outcomes. Careful consideration of dialysis modality in the management of CV surgery patients is needed to optimize clinical outcomes and reduce health care costs.