BACKGROUND: Few studies have examined the effectiveness of a risk-stratified approach to screening kidney transplantation candidates for ischemic heart disease (IHD). METHODS: We retrospectively reviewed records from all adult patients (n = 514) placed on the deceased donor kidney transplantation waiting list at a single center between January 1992 and June 2000. During this time there was a consistent policy for high-risk patients to undergo noninvasive stress testing and/or coronary angiography. We examined screening tests, the resulting interventions, and the incidence of subsequent IHD events (myocardial infarction, angioplasty, bypass surgery, or IHD death) among those screened and not screened. RESULTS: For 224 (43.6%) low-risk patients who were not screened, the actuarial incidence of an IHD event after listing (before or after transplantation) was only 0.5% at 1 year, 3.5% at 3 years, and 5.3% at 5 years. Screening 290 (56.4%) high-risk patients resulted in prophylactic angioplasty in 18 (6.2%), and bypass surgery in 8 (2.8%) before listing. After listing, 61 patients were screened, resulting in angioplasty in 6 (9.8%) and bypass surgery in 1 (1.6%). Of the 68 patients who ultimately had an IHD event after being placed on the waiting list, only 13 (19.4%) had not been screened. CONCLUSIONS: A risk-stratified screening strategy effectively avoided unnecessary testing in 43.6%. However, the relatively low proportion of screened patients who underwent prophylactic angioplasty or bypass grafting raises the question of whether screening was effective in preventing IHD events.
BACKGROUND: Few studies have examined the effectiveness of a risk-stratified approach to screening kidney transplantation candidates for ischemic heart disease (IHD). METHODS: We retrospectively reviewed records from all adult patients (n = 514) placed on the deceased donor kidney transplantation waiting list at a single center between January 1992 and June 2000. During this time there was a consistent policy for high-risk patients to undergo noninvasive stress testing and/or coronary angiography. We examined screening tests, the resulting interventions, and the incidence of subsequent IHD events (myocardial infarction, angioplasty, bypass surgery, or IHD death) among those screened and not screened. RESULTS: For 224 (43.6%) low-risk patients who were not screened, the actuarial incidence of an IHD event after listing (before or after transplantation) was only 0.5% at 1 year, 3.5% at 3 years, and 5.3% at 5 years. Screening 290 (56.4%) high-risk patients resulted in prophylactic angioplasty in 18 (6.2%), and bypass surgery in 8 (2.8%) before listing. After listing, 61 patients were screened, resulting in angioplasty in 6 (9.8%) and bypass surgery in 1 (1.6%). Of the 68 patients who ultimately had an IHD event after being placed on the waiting list, only 13 (19.4%) had not been screened. CONCLUSIONS: A risk-stratified screening strategy effectively avoided unnecessary testing in 43.6%. However, the relatively low proportion of screened patients who underwent prophylactic angioplasty or bypass grafting raises the question of whether screening was effective in preventing IHD events.
Authors: Nicola Kumar; Christopher S R Baker; Kakit Chan; Neill Duncan; Iqbal Malik; Andrew Frankel; Damien R Ashby; Adam McLean; Andrew Palmer; Tom D Cairns; David Taube Journal: Clin J Am Soc Nephrol Date: 2011-07-07 Impact factor: 8.237
Authors: Sean A Enkiri; Angela M Taylor; Ellen C Keeley; Lewis C Lipson; Lawrence W Gimple; Michael Ragosta Journal: Catheter Cardiovasc Interv Date: 2010-11-15 Impact factor: 2.692
Authors: Krista L Lentine; Frank P Hurst; Rahul M Jindal; Todd C Villines; Jeffrey S Kunz; Christina M Yuan; Paul J Hauptman; Kevin C Abbott Journal: Am J Kidney Dis Date: 2009-09-23 Impact factor: 8.860
Authors: D G Jones; A M Taylor; S A Enkiri; P Lobo; K L Brayman; E C Keeley; L C Lipson; L W Gimple; M Ragosta Journal: Am J Transplant Date: 2009-06-16 Impact factor: 8.086
Authors: Krista L Lentine; Mark A Schnitzler; Daniel C Brennan; Jon J Snyder; Paul J Hauptman; Kevin C Abbott; David Axelrod; Paolo R Salvalaggio; Bertram Kasiske Journal: Clin J Am Soc Nephrol Date: 2008-04-16 Impact factor: 8.237
Authors: Rajan K Patel; Christopher Pennington; Kathryn K Stevens; Alison Taylor; Keith Gillis; Elaine Rutherford; Nicola Johnston; Alan G Jardine; Patrick B Mark Journal: Transplant Res Date: 2014-12-03