One type of open heart surgery is likely safer than the other for chronic kidney disease (CKD) patients, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).
Open heart, or coronary artery bypass, surgery can be done two ways: on-pump or off-pump, depending on whether the patient is put on a heart-lung machine. Off-pump surgery allows a surgeon to perform a bypass without stopping the heart. This may help cut down on kidney injuries that can arise after heart surgery, which can deprive the kidneys of normal blood flow.
While patients with CKD often have heart problems, they’re usually excluded from heart bypass clinical trials and are often undertreated for heart disease.
Lakhmir Chawla, MD (George Washington University) and his colleagues looked to see if off-pump bypass surgery helps protect the kidneys of CKD patients compared with on-pump surgery. The investigators studied 742,909 bypass surgery patients (158,561 or 21.4% of whom underwent off-pump surgery) from 2004 to 2009.
CKD patients with particularly poor kidney function were more than three times as likely to die or need dialysis during the study when they underwent on-pump surgery compared with off-pump surgery.
“Our data suggest that excluding CKD patients from clinical trials of off-pump surgery may have resulted in an underestimation of potential benefit for this patient subgroup,” said Dr. Chawla. “If you need to have bypass surgery and you have CKD, an operative approach that does not involve the heart-lung machine may help avoid the need for dialysis,” he added.
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Study co-authors include Lakhmir Chawla MD; Yue Zhao, MD, PhD; Fredrick Lough, MD; Elizabeth Schroeder, MD; Michael Seneff, MD; and J. Matthew Brennan, MD.
Disclosures: The authors reported no financial disclosures related to this study, but Dr. Chawla receives consulting fees from Astute medical, Abbott, Alere Medical, Nxstage Medical, Gambro, and Covidien Medical.
The article, entitled “Off-Pump versus On-Pump CABG Outcomes Stratified by Pre-Operative Renal Function,” will appear online at http://jasn.asnjournals.org/ on May 17, 2012, doi: 10.1681/ASN.2012020122.
The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.
Founded in 1966, and with more than 13,500 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.
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Highlight
One type of open heart surgery is safer than the other – in terms of both health and survival – for chronic kidney disease patients.
Heart disease is the leading cause of death in individuals with chronic kidney disease.
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Tracy Hampton
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American Society of Nephrology
