Cardiac surgery in the end-stage renal disease population: General considerations, risk factors and clinical outcomes

End-stage renal disease (ESRD) continues to be an important health care problem in the United States due to the aging population and increase in the incidence of risk factors. Despite the new and evolving technologies, as well as advances in renal replacement therapies and kidney transplantation, the prognosis of this population remains unfavorable. Approximately 50% of deaths are caused by cardiovascular events; hence, cardiovascular disease is the single best predictor of death. The high prevalence of cardiovascular disease is attributable to the presence of multiple factors such as advanced age and the improvements in survival. In recent years, cardiovascular disease has led to a significant increase in the number of referrals of ESRD and dialysis-dependent patients for cardiac surgery, including coronary revascularization and heart valve surgery. Several clinical studies have shown that the outcomes of this population are worse compared to those without ESRD, with an increased morbidity and mortality following surgery. Indeed, a better understanding of the cause of deterioration and morbidity and mortality among patients with ESRD may help to improve the poor surgical outcomes in this challenging population. However, the most effective treatment for cardiovascular events among the ESRD population is still prevention.