Time to Rethink Surveillance Testing Prior to Kidney Transplant

Ruzieh, Mohammed; Foy, Andrew

doi:10.1001/jamainternmed.2020.2668

Cited by 2 publications

(5 citation statements)

References 6 publications

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“…However, this approach can produce variability in the selection and evaluation processes across centers and limit transparency, accountability, and opportunities for stakeholder input, features that are critical for ensuring a fair allocation system . The use of subjective and non–evidence-based selection criteria and the rigidity with which these criteria are applied may have the unintended consequence of leaving patients and families vulnerable to the harms of overtesting, implicit bias, and discriminatory practices . In particular, we suspect that requirements for complete abstinence from substances (including legal substances), narrow definitions of acceptable social support, and insistence on “compliance” with a wide range of medical recommendations may have disproportionately impacted the most disadvantaged members of the cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings highlight the need for a more person-centered and equitable approach to the kidney transplant evaluation and selection process (eFigure 2 in the Supplement). An evaluation and selection process that is more substantially guided by high-quality evidence and communally accepted principles of fairness and social justice could limit the burden of irrelevant testing procedures and protect patients from harmful, arbitrary, and/or discriminatory evaluation and selection practices . More open communication and collaboration between the transplant center and patients’ local medical centers could also allow for greater transparency and flexibility in the evaluation process.…”

Section: Discussionmentioning

confidence: 99%

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Thematic Analysis of the Health Records of a National Sample of US Veterans With Advanced Kidney Disease Evaluated for Transplant

et al. 2021

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Key Points Question What types of clinical care are involved in the kidney transplant evaluation process in real-world clinical settings? Findings In this qualitative study of the electronic health records of 211 US veterans with advanced kidney disease who were referred for kidney transplant evaluation, 4 dominant themes were identified describing clinical care during the evaluation process: far-reaching and inflexible medical evaluation, psychosocial valuation, surveillance over compliance, and disempowerment and lack of transparency. Meaning In this study, clinician documentation in the medical record indicated that, to be considered for a kidney transplant, patients were required to participate in a rigid, demanding, and opaque evaluation process over which they and their local clinicians had little control.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Thematic Analysis of the Health Records of a National Sample of US Veterans With Advanced Kidney Disease Evaluated for Transplant

et al. 2021

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“…These recommendations, like those used in the case from Ruzieh and Foy, have remained consistent despite a sea change in our understanding of chronic CAD. The value of CAD screening in asymptomatic populations is limited.…”

mentioning

confidence: 73%

“…In this issue of JAMA Internal Medicine , Ruzieh and Foy report the outcome of an asymptomatic patient in their 70s requiring kidney transplant who underwent cardiac evaluation. Noninvasive assessment revealed clinically silent coronary artery disease (CAD), prompting cardiac catheterization on 2 occasions, with a complication occurring the second time that caused heart failure and required emergency cardiac surgery.…”

mentioning

confidence: 99%

Screening Asymptomatic Kidney Transplant Candidates—Primum Non Nocere

Beckman

McEvoy

2020

JAMA Intern Med

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“…Patients experience the burden of frequent travel to and from transplant centers and financial repercussions . Noninvasive studies are often followed by invasive studies, such as cardiac computed tomography angiography or coronary angiography . Some patients with advanced chronic kidney disease experience rapid progression to ESKD because of nephrotoxic contrast agents used for cardiac imaging, such as invasive angiography.…”

mentioning

confidence: 99%

Coronary Heart Disease Testing Before Kidney Transplant—A Call for Revised Guidance

2023

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End-stage kidney disease (ESKD) is a debilitating chronic illness for which kidney transplant is the treatment of choice, as it reduces mortality, improves quality of life, and lowers costs compared with dialysis. Professional societies recommend cardiac evaluation for transplant candidacy because patients with ESKD are at increased risk of cardiovascular disease. 1 There has been substantial debate regarding the risks and benefits of such pretransplant evaluation, but to our knowledge few clinical data. To fill this evidence gap, the study in a recent issue of JAMA Internal Medicine by Cheng and colleagues 2 examined the association between pretransplant coronary heart disease (CHD) testing in asymptomatic patients and early postoperative adverse events. Using Medicare data on all 79 334 patients undergoing first-time kidney transplant from 2000 to 2014, they found that pretransplant CHD testing was performed in 56% of patients at the most test-intensive transplant programs compared with 24% at the least testintensive programs. Routine pretransplant CHD testing was not associated with significant reduction in death or acute myocardial infarction within 30 days of transplant. In fact, they found a nonsignificant increase in adverse events at centers with higher rates of CHD testing. Cheng et al 2 were not able to include outcomes of CHD testing in patients who did not proceed to undergo transplant. While the consequences of such testing in patients who are not ultimately listed for transplant is unknown, to our knowledge there is no study in any population that shows a benefit to CHD testing in asymptomatic persons, with or without ESKD.This study should inform professional society guidelines surrounding pretransplant CHD testing. New guidelines from the American Heart Association and American College of Cardiology 3 (and endorsed by the American Society of Transplantation) recommend screening electrocardiogram and echocardiogram for asymptomatic patients with unknown CHD status before transplant listing, updating previous guidelines that recommended noninvasive stress testing regardless of functional status in patients with 3 or more risk factors (diabetes, greater than 1 year receiving dialysis, prior cardiovascular disease, left ventricular hypertrophy, older than 60 years, smoking history, hypertension, or dyslipidemia). 4 The nonprofit

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Time to Rethink Surveillance Testing Prior to Kidney Transplant

Cited by 2 publications

References 6 publications

Thematic Analysis of the Health Records of a National Sample of US Veterans With Advanced Kidney Disease Evaluated for Transplant

Thematic Analysis of the Health Records of a National Sample of US Veterans With Advanced Kidney Disease Evaluated for Transplant

Screening Asymptomatic Kidney Transplant Candidates—Primum Non Nocere

Coronary Heart Disease Testing Before Kidney Transplant—A Call for Revised Guidance

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