Decreased Morbidity in Peritoneal Dialysis Patients Undergoing Coronary Artery Bypass Graft

Sir: Recently it has been reported that hemodialysis patients undergoing coronary artery bypass (CAB) have an increased morbidity ( 1) .We authors attributed this to the pathophysiologic changes resulting from endstage renal disease (ESRD), including hypertension, high cardiac output, and myocardial infarction. We would like to report our more favorable experience with CAB in patients maintained on peritoneal dialysis before, during, and after the operation. Ten male ESRD patients (three with polycystic kidney disease, two with diabetic nephropathy, two with glomerulonephritis, two with nephrosclerosis, one with pyelonephritis; age 40 to 70 years old) had an ejection fraction ranging from 33 to 67%. All were maintained on chronic peritoneal dialysis (2 on IPD and 8 on CAPD) and had undergone coronary artery bypass grafting at Toronto Western Hospital over the last 5 years. All had angina pectoris (New York Heart Association functional class III-IV) and triple vessel disease; 3 had suffered myocardial infarction in the past. All patients except one had had elective coronary angiography and bypass surgery. Before operation, all were treated with intermittent peritoneal dialysis for 24 to 48 h for optimal fluid and electrolyte control; after operation continuous (ambulatory) peritoneal dialysis was instituted as described previously (2). None suffered perioperative acute myocardial infarction. One of the 10 whose mitral valve was replaced during the bypass died 12 h after the procedure from pump failure, due to a previously undiagnosed, extensive myocardial infiltration with sarcoid granuloma. Comparison of postoperative morbidity in hemodialysis-Deutch et al.'s group (n = 16)-with our peritoneal dialysis group (n = 10) shows that ours had a more favorable outcome. The duration of mechanical ventilation in the former was 4.7 ± 2.3 compared to 1.0 day in ours (mean ± SE); their length of stay in intensive care unit was 6.4 ± 2.4 compared with ours of 3.7 ± 0.5 days; their length of postoperative hospital stay was 15.4 ± 2.1 compared to ours of 10.6 ± 1.5 days; and the length of hemodynamic support was 4.2 ± 2.3 days; two patients on peritoneal dialysis received dopamine for 1 day each and a third received it for 3 days; these periods were shorter in the peritoneal group. Four patients on hemodialysis had intraoperative myocardial infarctions while there were none in our peritoneal