Kidney Outcomes in Pediatric ANCA-Associated Vasculitis

Among patients on dialysis undergoing cardiovascular surgery, peritoneal dialysis (PD) is associated with reduced mortality and other adverse outcomes compared with hemodialysis (HD), reports a study in Kidney360.From the National Inpatient Sample, the researchers identified 30,155 patients on HD or PD who underwent coronary artery bypass grafting or valve replacement surgery between 2016 and 2020.In-hospital mortality and a range of secondary morbidity outcomes were compared between dialysis groups, with adjustment for potential confounders.Approximately 7% of patients were receiving PD.Coronary artery bypass surgery was performed in 78.5% of patients and valve replacement in 34.3%, with 12.8% undergoing combined surgery.PD was associated with lower rates of all outcomes of interest.In-hospital mortality was 4.4% in the PD group versus 7.8% in the HD group (odds ratio, 6.1 on adjusted analysis).PD was also associated with a lower incidence of prolonged ventilation (over 96 hours; odds ratio, 0.51) and a shorter average length of stay (incidence rate ratio, 0.85).Patients receiving PD also had lower hospital charges (mean difference, $-87,172).Findings were "largely consistent" in subgroup and exploratory analyses.Approximately one-fourth of patients initially on PD switched to HD-a transition associated with substantial increases in prolonged ventilation, length of stay, and hospital charges.Patients who switched from PD to HD also had higher in-hospital mortality, although the difference was not statistically significant.Patients on dialysis undergoing cardiovascular surgery are at greatly increased risk of adverse outcomes.Patients on PD have sometimes been electively converted to HD, historically, due to perceived higher complication rates.This large, retrospective study suggests that patients on PD undergoing cardiovascular surgery have lower rates of adverse outcomes compared with those on HD.The researchers conclude: "Protocols should be developed to optimize the care of [patients on PD] undergoing cardiac surgery, with the goal of maintaining PD whenever possible" [Shah A, et al.Impact of dialysis modality on mortality and complications in cardiovascular surgery: Insights from a national retrospective cohort study.Kidney360, published online