Impact of renal disease in cardiovascular surgery: emphasis on the African-American patient  William A Cooper, MD, William Brinkman, MD, Rebecca J Petersen, RN, BA, Robert A Guyton, MD  The Annals of Thoracic Surgery  Volume 76, Issue 4, Pages S1370-S1376 (October 2003) DOI: 10.1016/S0003-4975(03)01204-9

Fig 1 Trends in incident rates and annual percent change. Rates adjusted for age, gender, and race. The incidence of dialysis dependent renal failure has continued to increase over the past 20 years. The rate of new cases increased by 5% to 10% over this time period. The overall incidence is higher in the African American subgroup, however, new cases are similar to Caucasians. [Reprinted from U.S. Renal Data System, USRDS 2002 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2002. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government.] The Annals of Thoracic Surgery 2003 76, S1370-S1376DOI: (10.1016/S0003-4975(03)01204-9)

Fig 2 Annual trend of dialysis-dependent open heart procedures from Crawford Long and Emory University Hospitals from 1994 through 2001. The Annals of Thoracic Surgery 2003 76, S1370-S1376DOI: (10.1016/S0003-4975(03)01204-9)

Fig 3 Costs of the end-stage renal disease (ESRD) and Medicare program dollars in 2000 are inflated by 2% to account for costs incurred not reported. Medicare expenditures have increased coincident with the increasing number of patients requiring dialysis. Annual cost has more than doubled and the percent of expenditures allocated to dialysis programs have increased similarly (green line = total medicare dollars; red line = total dialysis dollars; blue bars = ESRD percent of medicare dollars). [Reprinted from U.S. Renal Data System, USRDS 2002 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2002. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government.] The Annals of Thoracic Surgery 2003 76, S1370-S1376DOI: (10.1016/S0003-4975(03)01204-9)

Fig 4 All cause survival; results of invasive coronary artery procedures in dialysis patients could be of some inherent benefit. It remains to be demonstrated in a prospective fashion which procedures may have the most impact on patient long-term survival. (CAB = coronary artery bypass; IMA = internal mammary artery; PTCA = percutaneous transluminal coronary angioplasty.) The Annals of Thoracic Surgery 2003 76, S1370-S1376DOI: (10.1016/S0003-4975(03)01204-9)

Fig 5 Incident end-stage renal disease (ESRD) and survival probability adjusted for age, gender, race, and primary diagnosis. The incident cohorts and associated modalities are determined at the time of ESRD initiation with the 60-day stable modality rule and the 90-day rule. Age as of date of ESRD initiation. Unknown age, gender; other and unknown, and primary diagnosis are excluded. [Reprinted from U.S. Renal Data System, USRDS 2002 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2002. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government.] The Annals of Thoracic Surgery 2003 76, S1370-S1376DOI: (10.1016/S0003-4975(03)01204-9)

Fig 6 Mortality by creatinine clearance from The Society of Thoracic Surgeons national adult cardiac registry of coronary artery bypass procedures, May 2000 through December 2001. Although African-American patients tend to live longer once dialysis is initiated, the impact of renal dysfunction on those undergoing coronary artery bypass procedures is profound. No appreciable ethnic differences exist in coronary artery bypass patients. The Annals of Thoracic Surgery 2003 76, S1370-S1376DOI: (10.1016/S0003-4975(03)01204-9)

Fig 7 Annual trend of dialysis dependent coronary artery bypass (CAB) or valve procedures at Crawford Long and Emory University Hospitals from 1994 through 2001. (ESRD = end-stage renal disease.) The Annals of Thoracic Surgery 2003 76, S1370-S1376DOI: (10.1016/S0003-4975(03)01204-9)