Impact of Chronic Kidney Disease and Dialysis on Outcome after Surgery for Infective Endocarditis

Author:

Elderia Ahmed1ORCID,Kiehn Ellen1,Djordjevic Ilija1ORCID,Gerfer Stephen1ORCID,Eghbalzadeh Kaveh1,Gaisendrees Christopher1,Deppe Antje-Christin1,Kuhn Elmar1,Wahlers Thorsten1ORCID,Weber Carolyn1ORCID

Affiliation:

1. Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50937 Köln, Germany

Abstract

Infective endocarditis (IE) carries a heavy burden of morbidity and mortality in chronic kidney disease (CKD) and hemodialysis (HD) patients. We investigated the risk factors, pathognomonic profile and outcomes of surgically treated IE in CKD and HD patients. We preoperatively identified patients with CKD under hemodialysis (HD group) and compared them with patients without hemodialysis (Non-HD group). Furthermore, we divided the cohort into four groups according to the underlying stage of CKD, with a subsequent outcome analysis. Between 2009 and 2018, 534 Non-HD and 58 HD patients underwent surgery for IE at our institution. The median age was 65.1 [50.6–73.6] and 63.2 [53.4–72.8] years in the Non-HD and HD groups, respectively (p = 0.861). The median EuroSCORE II was 8.0 [5.0–10.0] vs. 9.5 [7.0–12.0] in the Non-HD vs. HD groups (p = 0.004). Patients without CKD had a mortality rate of 5.6% at 30 days and 15.5% at 1 year. Mortality rates proportionally rose with the severity of CKD. Among HD patients, 30-day and 1-year mortality rates were 38.1% and 75.6%, respectively (p < 0.001). Staphylococcus aureus IE was significantly more frequent in the HD group (p = 0.006). In conclusion, outcomes after surgery for IE correlated with the severity of the underlying CKD, with HD patients exhibiting the most unfavorable results. Pre-existing CKD and staphylococcus aureus infection were independent risk factors for 1-year mortality.

Publisher

MDPI AG

Subject

General Medicine

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