Prognostic Value of Cardiovascular Screening in Potential Renal Transplant Recipients: Single-Center Prospective Observational Study

Abstract

We assessed the outcome of pretransplant cardiac assessment in a single center. Three hundred patients with end-stage renal disease underwent electrocardiogram, Bruce exercise testing (ETT) and ventricular assessment by cardiac MRI. Patients with high index of suspicion of coronary artery disease (CAD) underwent coronary angiography and percutaneous coronary intervention (PCI) if indicated. Two hundred and twentytwo patients were accepted onto the renal transplant waiting list; 80 patients were transplanted during the follow-up period and 60 died (7 following transplantation). Successful transplantation was associated with improved survival (mean survival 4.5 ± 0.6 years vs. listed not transplanted 4.1 ± 1.4 years vs. not listed 3.1 ± 1.7 years; p < 0.001). Ninety-nine patients underwent coronary angiography; 65 had normal or lowgrade CAD and 34 obstructive CAD. Seventeen patients (5.6%) were treated by PCI. There was no apparent survival difference between patients who underwent PCI or coronary artery bypass graft compared to those who underwent angiography without intervention or no angiography (p = 0.67). Factors associated with nonlisting for renal transplantation included burden of preexisting cardiovascular disease, poor exercise tolerance and severity of CAD. Pretransplant cardiovascular screening provides prognostic information and information that can be used to restrict access to transplantation. However, if the aim is to identify and treat CAD, the benefits are far from clear.

Effect of Elective Coronary Angiography on Glomerular Filtration Rate in Patients with Advanced Chronic Kidney Disease

“…This significantly impacts the cardiac assessment of potential renal transplant recipients and how to manage coronary artery lesions that are identified. A recent prospective study in a Scottish CKD population challenged the current practice of coronary angiographic screening (24). The authors reported no direct evidence of patient benefit from cardiac screening, and in fact suggested that it may serve as a barrier to being placed on a waiting list.…”

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

“…A baseline transthoracic echocardiogram performed at dry weight is also important because it can help identify impaired LVEF and wall motion abnormalities, which may be signs of prognostically significant CAD 26. A normal cardiac stress test has a high negative predictive value for cardiovascular events27, 28 in the perioperative and follow‐up periods, as shown in a study of renal transplant candidates undergoing preoperative SPECT 29. A hybrid SPECT/computed tomography scan assesses for ischemia and coronary artery calcification, which is highly prevalent in patients with ESRD 30.…”

Determinants of Left Ventricular Mass and Hypertrophy in Hemodialysis Patients Assessed by Cardiac Magnetic Resonance Imaging

“…Since 2002 (10,11,13), we have used CMR as part of the standard assessment of patients for renal transplantation. The renal transplant unit at the Western Infirmary (Glasgow, Scotland, UK) provides transplant services to a population of 2.8 million people in the west of Scotland.…”