Miscellaneous| Volume 117, ISSUE 1, P146-150, January 01, 2016

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Cardiovascular Risk Assessment and Management in Prerenal Transplantation Candidates

Published:October 18, 2015DOI:
      Cardiovascular (CV) assessment in prerenal transplant patients varies by center. Current guidelines recommend stress testing for candidates if ≥3 CV risk factors exist. We evaluated the CV assessment and management in 685 patients referred for kidney transplant over a 7-year period. All patients had CV risk factors, and the most common cause of end-stage renal disease was diabetes. Thirty-three percent (n = 229) underwent coronary angiography. The sensitivity of stress testing to detect obstructive coronary artery disease (CAD) was poor (0.26). Patients who had no CAD, nonobstructive CAD, or CAD with intervention had significantly higher event-free survival compared with patients with obstructive CAD without intervention. There were no adverse clinical events (death, myocardial infarction, stroke, revascularization, and graft failure) within 30 days post-transplant in patients who had preoperative angiography (n = 77). Of the transplanted patients who did not have an angiogram (n = 289), there were 8 clinical events (6 myocardial infarctions) in the first 30 days. In conclusion, our results indicate that stress testing and usual risk factors were poor predictors of obstructive CAD and that revascularization may prove beneficial in these patients.
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        • United States Renal Data System
        Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States.
        National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda2013
        • Stoumpos S.
        • Jardine A.G.
        • Mark P.B.
        Cardiovascular morbidity and mortality after kidney transplantation.
        Transpl Int. 2015; 28: 10-21
        • Charytan D.
        • Kuntz R.E.
        • Mauri L.
        • DeFilippi C.
        Distribution of coronary artery disease and relation to mortality in asymptomatic hemodialysis patients.
        Am J Kidney Dis. 2007; 49: 409-416
        • Gill J.S.
        • Ma I.
        • Landsberg D.
        • Johnson N.
        • Levin A.
        Cardiovascular events and investigation in patients who are awaiting cadaveric kidney transplantation.
        J Am Soc Nephrol. 2005; 16: 808-816
        • Lentine K.L.
        • Costa S.P.
        • Weir M.R.
        • Robb J.F.
        • Fleisher L.A.
        • Kasiske B.L.
        • Carithers R.L.
        • Ragosta M.
        • Bolton K.
        • Auerbach A.D.
        • Eagle K.A.
        • American Heart Association Council on the Kidney in Cardiovascular Disease, Council on Peripheral Vascular Disease, American Heart Association, American College of Cardiology Foundation
        Cardiac disease evaluation and management among kidney and liver transplantation candidates: a scientific statement from the American Heart Association and the American College of Cardiology Foundation: endorsed by the American Society of Transplant Surgeons, American Society of Transplantation, and National Kidney Foundation.
        Circulation. 2012; 126: 617-663
        • EBPG (European Expert Group on Renal Transplantation); European Renal Association (ERA-EDTA); European Society for Organ Transplantation (ESOT)
        European best practice guidelines for renal transplantation (part 1).
        Nephrol Dial Transplant. 2000; 15: 1-85
        • Kasiske B.L.
        • Cangro C.B.
        • Hariharan S.
        • Hricik D.E.
        • Kerman R.H.
        • Roth D.
        • Rush D.N.
        • Vazquez M.A.
        • Weir M.R.
        The evaluation of renal transplantation candidates: clinical practice guidelines.
        Am J Transplant. 2001; 1: 3-95
        • Abbud-Filho M.
        • Adams P.L.
        • Alberu J.
        • Cardella C.
        • Chapman J.
        • Cochat P.
        • Cosio F.
        • Danovitch G.
        • Davis C.
        • Gaston R.S.
        • Humar A.
        • Hunsicker L.G.
        • Josephson M.A.
        • Kasiske B.
        • Kirste G.
        • Leichtman A.
        • Munn S.
        • Obrador G.T.
        • Tibell A.
        • Wadstrom J.
        • Zeier M.
        • Delmonico F.L.
        A report of the Lisbon Conference on the care of the kidney transplant recipient.
        Transplantation. 2007; 83: S1-22
        • Kumar N.
        • Baker C.S.
        • Chan K.
        • Duncan N.
        • Malik I.
        • Frankel A.
        • Ashby D.R.
        • McLean A.
        • Palmer A.
        • Cairns T.D.
        • Taube D.
        Cardiac survival after pre-emptive coronary angiography in transplant patients and those awaiting transplantation.
        Clin J Am Soc Nephrol. 2011; 6: 1912-1919
        • Marwick T.H.
        • Steinmuller D.R.
        • Underwood D.A.
        • Hobbs R.E.
        • Go R.T.
        • Swift C.
        • Braun W.E.
        Ineffectiveness of dipyridamole SPECT thallium imaging as a screening technique for coronary artery disease in patients with end-stage renal failure.
        Transplantation. 1990; 49: 100-103
        • Boudreau R.
        Perfusion thallium imaging of type I diabetes patients with end stage renal disease: comparison of oral and intravenous dipyridamole administration.
        Card Radiol. 1990; 175: 103-105
        • Vandenberg B.F.
        • Rossen J.D.
        • Grover-McKay M.
        • Shammas N.W.
        • Burns T.L.
        • Rezai K.
        Evaluation of diabetic patients for renal and pancreas transplantation: noninvasive screening for coronary artery disease using radionuclide methods.
        Transplantation. 1996; 62: 1230-1235
        • Herzog C.A.
        • Marwick T.H.
        • Pheley A.M.
        • White C.W.
        • Rao V.K.
        • Dick C.D.
        Dobutamine stress echocardiography for the detection of significant coronary artery disease in renal transplant candidates.
        Am J Kidney Dis. 1999; 33: 1080-1090
        • Worthley M.I.
        • Unger S.A.
        • Mathew T.H.
        • Russ G.R.
        • Horowitz J.D.
        Usefulness of tachycardic-stress perfusion imaging to predict coronary artery disease in high-risk patients with chronic renal failure.
        Am J Cardiol. 2003; 92: 1318-1320
        • De Lima J.J.
        • Gowdak L.H.
        • de Paula F.J.
        • Arantes R.L.
        • de Oliveira A.L.
        • Ramires J.A.
        • Cesar L.A.
        • Krieger E.M.
        Treatment of coronary artery disease in hemodialysis patients evaluated for transplant-a registry study.
        Transplantation. 2010; 89: 845-850
        • Sharma R.
        • Chemla E.
        • Tome M.
        • Mehta R.L.
        • Gregson H.
        • Brecker S.J.
        • Chang R.
        • Pellerin D.
        Echocardiography-based score to predict outcome after renal transplantation.
        Heart. 2007; 93: 464-469
        • Ferreira P.A.
        • de Lima V.C.
        • Campos Filho O.
        • Gil M.A.
        • Cordovil A.
        • Machado C.V.
        • Pestana J.O.
        • Carvalho A.C.
        Feasibility, safety and accuracy of dobutamine/atropine stress echocardiography for the detection of coronary artery disease in renal transplant candidates.
        Arq Bras Cardiol. 2007; 88: 45-51
        • Fihn S.D.
        • Gardin J.M.
        • Abrams J.
        • Berra K.
        • Blankenship J.C.
        • Dallas A.P.
        • Douglas P.S.
        • Foody J.M.
        • Gerber T.C.
        • Hinderliter A.L.
        • King III, S.B.
        • Kligfield P.D.
        • Krumholz H.M.
        • Kwong R.Y.
        • Lim M.J.
        • Linderbaum J.A.
        • Mack M.J.
        • Munger M.A.
        • Prager R.L.
        • Sabik J.F.
        • Shaw L.J.
        • Sikkema J.D.
        • Smith Jr., C.R.
        • Smith Jr., S.C.
        • Spertus J.A.
        • Williams S.V.
        2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.
        J Am Coll Cardiol. 2012; 60: e44-e164
        • McFalls E.O.
        • Ward H.B.
        • Moritz T.E.
        • Goldman S.
        • Krupski W.C.
        • Littooy F.
        • Pierpont G.
        • Santilli S.
        • Rapp J.
        • Hattler B.
        • Shunk K.
        • Jaenicke C.
        • Thottapurathu L.
        • Ellis N.
        • Reda D.J.
        • Henderson W.G.
        Coronary-artery revascularization before elective major vascular surgery.
        N Engl J Med. 2004; 351: 2795-2804
        • McFalls E.O.
        • Ward H.B.
        • Moritz T.E.
        • Littooy F.
        • Santilli S.
        • Rapp J.
        • Larsen G.
        • Reda D.J.
        Clinical factors associated with long-term mortality following vascular surgery: outcomes from the Coronary Artery Revascularization Prophylaxis (CARP) Trial.
        J Vasc Surg. 2007; 46: 694-700
        • Manske C.L.
        • Wang Y.
        • Rector T.
        • Wilson R.F.
        • White C.W.
        Coronary revascularisation in insulin-dependent diabetic patients with chronic renal failure.
        Lancet. 1992; 340: 998-1002