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Pretransplant cardiac stress testing and transplant wait time in kidney transplantation candidates.
Lee, Ming-Sum; Batiste, Columbus; Onwuzurike, James; Elkoustaf, Rachid; Wu, Yi-Lin; Chen, Wansu; Kahwaji, Joseph; Sahota, Amandeep; Lee, Roland L.
Afiliación
  • Lee MS; Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA mingsum.lee@kp.org.
  • Batiste C; Department of Cardiology, Kaiser Permanente Riverside Medical Center, Riverside, California, USA.
  • Onwuzurike J; Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA.
  • Elkoustaf R; Department of Cardiology, Kaiser Permanente Riverside Medical Center, Riverside, California, USA.
  • Wu YL; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
  • Chen W; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
  • Kahwaji J; Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA.
  • Sahota A; Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA.
  • Lee RL; Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA.
Open Heart ; 11(2)2024 Sep 13.
Article en En | MEDLINE | ID: mdl-39277185
ABSTRACT

OBJECTIVE:

Routine screening for cardiovascular disease before kidney transplantation remains controversial. This study aims to compare cardiac testing rates in patients with end-stage renal disease, referred and not referred for transplantation, and assess the impact of testing on transplant wait times.

METHODS:

This is a retrospective cohort study of 22 687 end-stage renal disease patients from 2011 to 2022, within an integrated health system. Cardiac testing patterns, and the association between cardiac testing and transplant wait times and post-transplant mortality were evaluated.

RESULTS:

Of 22 687 patients (median age 66 years, 41.1% female), 6.9% received kidney transplants, and 21.0% underwent evaluation. Compared with dialysis patients, transplant patients had a 5.6 times higher rate of stress nuclear myocardial perfusion imaging with single-photon emission (rate ratio (RR) 5.64, 95% CI 5.37 to 5.92), a 6.5 times higher rate of stress echocardiogram (RR 6.51, 95% CI 5.65 to 7.51) and 16% higher cardiac catheterisation (RR 1.16, 95% CI 1.06 to 1.27). In contrast, revascularisation rates were significantly lower in transplant patients (RR 0.46, 95% CI 0.36 to 0.58). Transplant wait times were longer for patients who underwent stress testing (median 474 days with no testing vs 1053 days with testing) and revascularisation (1796 days for percutaneous intervention and 2164 days for coronary artery bypass surgery). No significant association was observed with 1-year post-transplant mortality (adjusted OR 1.99, 95% CI 0.46 to 8.56).

CONCLUSIONS:

This study found a higher rate of cardiac testing in dialysis patients evaluated for kidney transplants. Cardiac testing was associated with longer transplant wait time, but no association was observed between testing and post-transplant mortality.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Listas de Espera / Trasplante de Riñón / Prueba de Esfuerzo / Fallo Renal Crónico Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Open Heart Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Listas de Espera / Trasplante de Riñón / Prueba de Esfuerzo / Fallo Renal Crónico Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Open Heart Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido