Bringing Back Blood Flow in Kidney Failure

Open heart surgery in kidney failure patients may be better option than angioplasty

(RxWiki News) Blocked arteries are a serious problem for kidney failure patients on dialysis. While surgeries to fix blocked arteries can be dangerous for dialysis patients, one type of surgery may be the better option.

Kidney failure patients may benefit more from open heart surgery to unblock arteries than from angioplasty, according to recent research.

Be that as it may, kidney failure patients may have a poor chance of survival 5 years later, regardless of the type of surgery. While only 22 to 25 percent of kidney failure patients survived 5 years after surgery, survival rates among patients without kidney disease are over 90 percent.

"Talk to your doctor about surgery options."

About 30 to 60 percent of kidney failure patients on dialysis have blocked arteries around the heart. However, it is unclear how to best fix this potentially deadly problem in these kidney patients.

To address this issue, Tara Chang, MD, of Stanford University School of Medicine, and colleagues tested the two procedures available to treat blocked arteries: open heart surgery, or coronary artery bypass grafting, and angioplasty, or percutaneous coronary intervention.

In open heart surgery, a healthy artery is taken from another part of the body then connected to the blocked artery. The new artery allows for blood to flow around the blocked portion of the old artery, which renews the flow of oxygen-rich blood to the heart.

Angioplasty involves a thin, flexible tube with a balloon at the tip. The tube is threaded through a blood vessel to the blocked artery. The balloon is then inflated to squeeze plaque (the substance that blocks arteries) up against the wall, allowing for blood to flow once again.

From their study, Dr. Chang and colleagues found that kidney failure patients who underwent open heart surgery had a 13 percent lower risk of death than those who underwent angioplasty.

In addition, open heart surgery was associated with a 12 percent lower risk of either dying or having a heart attack.

"It is important to note that because our study was observational, our results cannot prove that [open heart surgery] is better; only a randomized trial can do that," said Dr. Chang.

Putting together a randomized trial might be difficult at the moment, as dialysis patients have been excluded from trials on these two procedures.

"However, our study does offer guidance to patients and providers who must make these tough decisions and suggests that in carefully selected patients on dialysis with multivessel coronary heart disease, [open heart surgery] may be preferred rather than [angioplasty]," she said.

This observational study included 22,000 dialysis patients who underwent coronary artery bypass grafting or percutaneous coronary intervention. The research was published November 30 in the Journal of the American Society of Nephrology.

Review Date: 
November 29, 2012