Peritoneal Dialysis Is Associated with Lower Mortality and Morbidity Compared with Hemodialysis in Patients Undergoing Cardiovascular Surgery: A Retrospective Cohort Study
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".