Abstract: FR-PO455
Peritoneal Dialysis Is Associated with Lower Mortality and Morbidity Compared with Hemodialysis in Patients Undergoing Cardiovascular Surgery: A Retrospective Cohort Study
Session Information
- Home Dialysis - 1
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Shah, Ankur, Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
- El Shamy, Osama, The George Washington University, Washington, District of Columbia, United States
- Perl, Jeffrey, St. Michael's Hospital, University of Toronto,, Toronto, Ontario, Canada
- Raker, Christina A., Rhode Island Hospital, Providence, Rhode Island, United States
- Hu, Susie L., Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
Background
Patients receiving maintenance dialysis face high mortality and complication rates following cardiovascular (CV) surgery. With the growing utilization of peritoneal dialysis (PD), it is important to understand the impact of modality on outcomes following CV surgery.
Methods
This retrospective cohort study used the National Inpatient Sample (2016-2020) to compare outcomes of PD and HD patients undergoing CV surgery . The primary outcome was in-hospital mortality, and secondary outcomes included prolonged ventilation, length of stay, and cost. The primary analysis used multivariable logistic regression to evaluate the association between dialysis modality and in-hospital mortality, adjusting for demographics, comorbid conditions, and hospital factors as potential confounders. Survey-specific analytic procedures incorporated discharge weights, sampling units, and sampling strata to generate nationally representative estimates for all analyses.
Results
A total of 30,155 patients were included in the study, with 28,015 (92.9%) receiving HD) and 2,140 (7.1%) receiving PD. Patients in the PD group experienced better outcomes compared to those in the HD group across all measured variables (table 4). The unadjusted mortality rate was lower in the PD group (4.4% vs 7.8%, OR 0.55, 95% CI 0.35-0.88), and this difference remained significant after adjustment (OR 0.61, 95% CI 0.38-0.97). Similarly, the incidence of prolonged ventilation was lower in the PD group (4.7% vs 9.7%, OR 0.45, 95% CI 0.29-0.71; aOR 0.51, 95% CI 0.32-0.81). The average length of stay was shorter in the PD group (13.6 vs 17.1 days, unadjusted IRR 0.79, 95% CI 0.74-0.85; adjusted IRR 0.85, 95% CI 0.80-0.91). Lastly, total charges were significantly lower in the PD group (mean $307,072 vs $407,556, unadjusted MD -$100,484, 95% CI -$124,773 to -$76,195; adjusted MD -$87,172, 95% CI -$113,523 to -$60,820). Among PD patients, post-operative transition to HD was associated with worse outcomes.
Conclusion
Maintaining PD during the perioperative period may confer benefits over HD, including lower healthcare costs and improved patient outcomes. Careful consideration of dialysis modality in the management of CV surgery patients is needed to optimize clinical outcomes and reduce healthcare costs.