Document Detail

Cardiovascular risk assessment among potential kidney transplant candidates: approaches and controversies.
MedLine Citation:
PMID:  19783341     Owner:  NLM     Status:  MEDLINE    
Cardiovascular disease is the most common cause of death after kidney transplantation. However, uncertainties regarding the optimal assessment of cardiovascular risk in potential transplant candidates have produced controversy and inconsistency in pretransplantation cardiac evaluation practices. In this review, we consider the evidence supporting cardiac evaluation in kidney transplant candidates, generally focused on coronary artery disease, according to the World Health Organization principles for screening. The importance of pretransplant cardiac evaluation is supported by the high prevalence of coronary artery disease and the incidence and adverse consequences of acute coronary syndromes in this population. Testing for coronary artery disease may be performed noninvasively by using modalities that include nuclear myocardial perfusion studies and dobutamine stress echocardiography. These tests have prognostic value for mortality, but imperfect sensitivity and specificity for detecting angiographically defined coronary artery disease in patients with end-stage renal disease. Associations of angiographically-defined coronary artery disease with subsequent survival also are inconsistent, likely because plaque instability is more critical for infarction risk than angiographic stenosis. The efficacy and best methods of myocardial revascularization have not been examined in large contemporary clinical trials in patients with end-stage renal disease. Biomarkers, such as cardiac troponin, have prognostic value in end-stage renal disease, but require further study to determine clinical applications in directing more expensive and invasive cardiac evaluation.
Krista L Lentine; Frank P Hurst; Rahul M Jindal; Todd C Villines; Jeffrey S Kunz; Christina M Yuan; Paul J Hauptman; Kevin C Abbott
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review     Date:  2009-09-23
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  55     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-07     Completed Date:  2010-02-02     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  152-67     Citation Subset:  IM    
Copyright Information:
Copyright 2009 National Kidney Foundation, Inc. All rights reserved.
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MeSH Terms
Cardiovascular Diseases / epidemiology*,  etiology
Kidney Failure, Chronic / surgery*
Kidney Transplantation / adverse effects*
Risk Assessment / methods*
Risk Factors
Survival Rate
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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