Assessing cardiovascular risk in chronic kidney disease patients prior to kidney transplantation: clinical usefulness of a standardised cardiovascular assessment protocol
Abstract Background Despite pre-kidney-transplant cardiovascular (CV) assessment being routine care to minimise perioperative risk, the utility of such assessment is not well established. The study reviewed the evaluation and outcome of a standardised CV assessment protocol. Methods Data were analys...
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| Format: | Article |
| Language: | English |
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BMC
2018-01-01
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| Series: | BMC Nephrology |
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| Online Access: | http://link.springer.com/article/10.1186/s12882-017-0795-z |
| _version_ | 1819058001926946816 |
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| author | Robin Ramphul Maria Fernandez Sam Firoozi Juan C. Kaski Rajan Sharma Debasish Banerjee |
| author_facet | Robin Ramphul Maria Fernandez Sam Firoozi Juan C. Kaski Rajan Sharma Debasish Banerjee |
| author_sort | Robin Ramphul |
| collection | DOAJ |
| description | Abstract Background Despite pre-kidney-transplant cardiovascular (CV) assessment being routine care to minimise perioperative risk, the utility of such assessment is not well established. The study reviewed the evaluation and outcome of a standardised CV assessment protocol. Methods Data were analysed for 231 patients (age 53.4 ± 12.9 years, diabetes 34.6%) referred for kidney transplantation between 1/2/2012-31/12/2014. One hundred forty-three patients were high-risk (age > 60 years, diabetes, CV disease, heart failure, peripheral vascular disease) and offered dobutamine stress echocardiography (DSE); 88 patients were low-risk and offered ECG and echocardiography with/without exercise treadmill test. Results At the end of follow-up (579 ± 289 days), 35 patients underwent kidney transplantation and 50 were active on the waitlist. There were 24 events (CV or death), none were perioperative. One hundred fifteen patients had DSE with proportionally more events in DSE-positive compared to DSE-negative patients (6/34 vs. 7/81, p = 0.164). In 42 patients who underwent coronary angiography due to a positive DSE or ischaemic heart disease symptoms, 13 (31%) had events, 6 were suspended, 11 removed from waitlist, 3 wait-listed, 1 transplanted and 17 still undergoing assessment. Patients with significant coronary artery disease requiring intervention had poorer event-free survival compared to those without intervention (56% vs. 83% at 2 years, p = 0.044). However, the association became non-significant after correction for CV risk factors (HR = 3.17, 95% CI 0.51–19.59, p = 0.215). Conclusions The stratified CV risk assessment protocol using DSE in all high-risk patients was effective in identifying patients with coronary artery disease. The coronary angiograms identified the event-prone patients effectively but coronary interventions were not associated with improved survival. |
| first_indexed | 2024-12-21T13:48:16Z |
| format | Article |
| id | doaj.art-5c7900c198f246f18566f394ee8fb211 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-21T13:48:16Z |
| publishDate | 2018-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-5c7900c198f246f18566f394ee8fb2112022-12-21T19:01:48ZengBMCBMC Nephrology1471-23692018-01-0119111210.1186/s12882-017-0795-zAssessing cardiovascular risk in chronic kidney disease patients prior to kidney transplantation: clinical usefulness of a standardised cardiovascular assessment protocolRobin Ramphul0Maria Fernandez1Sam Firoozi2Juan C. Kaski3Rajan Sharma4Debasish Banerjee5Renal and Transplantation Unit, St George’s University Hospitals NHS Foundation TrustRenal and Transplantation Unit, St George’s University Hospitals NHS Foundation TrustCardiology Clinical Academic Group, Molecular and Cell Sciences Research Institute, St George’s, University of LondonCardiology Clinical Academic Group, Molecular and Cell Sciences Research Institute, St George’s, University of LondonCardiology Clinical Academic Group, Molecular and Cell Sciences Research Institute, St George’s, University of LondonRenal and Transplantation Unit, St George’s University Hospitals NHS Foundation TrustAbstract Background Despite pre-kidney-transplant cardiovascular (CV) assessment being routine care to minimise perioperative risk, the utility of such assessment is not well established. The study reviewed the evaluation and outcome of a standardised CV assessment protocol. Methods Data were analysed for 231 patients (age 53.4 ± 12.9 years, diabetes 34.6%) referred for kidney transplantation between 1/2/2012-31/12/2014. One hundred forty-three patients were high-risk (age > 60 years, diabetes, CV disease, heart failure, peripheral vascular disease) and offered dobutamine stress echocardiography (DSE); 88 patients were low-risk and offered ECG and echocardiography with/without exercise treadmill test. Results At the end of follow-up (579 ± 289 days), 35 patients underwent kidney transplantation and 50 were active on the waitlist. There were 24 events (CV or death), none were perioperative. One hundred fifteen patients had DSE with proportionally more events in DSE-positive compared to DSE-negative patients (6/34 vs. 7/81, p = 0.164). In 42 patients who underwent coronary angiography due to a positive DSE or ischaemic heart disease symptoms, 13 (31%) had events, 6 were suspended, 11 removed from waitlist, 3 wait-listed, 1 transplanted and 17 still undergoing assessment. Patients with significant coronary artery disease requiring intervention had poorer event-free survival compared to those without intervention (56% vs. 83% at 2 years, p = 0.044). However, the association became non-significant after correction for CV risk factors (HR = 3.17, 95% CI 0.51–19.59, p = 0.215). Conclusions The stratified CV risk assessment protocol using DSE in all high-risk patients was effective in identifying patients with coronary artery disease. The coronary angiograms identified the event-prone patients effectively but coronary interventions were not associated with improved survival.http://link.springer.com/article/10.1186/s12882-017-0795-zKidney transplantationCardiovascular diseaseDobutamine stress echocardiographyCoronary angiographyCardiovascular eventsChronic kidney disease |
| spellingShingle | Robin Ramphul Maria Fernandez Sam Firoozi Juan C. Kaski Rajan Sharma Debasish Banerjee Assessing cardiovascular risk in chronic kidney disease patients prior to kidney transplantation: clinical usefulness of a standardised cardiovascular assessment protocol BMC Nephrology Kidney transplantation Cardiovascular disease Dobutamine stress echocardiography Coronary angiography Cardiovascular events Chronic kidney disease |
| title | Assessing cardiovascular risk in chronic kidney disease patients prior to kidney transplantation: clinical usefulness of a standardised cardiovascular assessment protocol |
| title_full | Assessing cardiovascular risk in chronic kidney disease patients prior to kidney transplantation: clinical usefulness of a standardised cardiovascular assessment protocol |
| title_fullStr | Assessing cardiovascular risk in chronic kidney disease patients prior to kidney transplantation: clinical usefulness of a standardised cardiovascular assessment protocol |
| title_full_unstemmed | Assessing cardiovascular risk in chronic kidney disease patients prior to kidney transplantation: clinical usefulness of a standardised cardiovascular assessment protocol |
| title_short | Assessing cardiovascular risk in chronic kidney disease patients prior to kidney transplantation: clinical usefulness of a standardised cardiovascular assessment protocol |
| title_sort | assessing cardiovascular risk in chronic kidney disease patients prior to kidney transplantation clinical usefulness of a standardised cardiovascular assessment protocol |
| topic | Kidney transplantation Cardiovascular disease Dobutamine stress echocardiography Coronary angiography Cardiovascular events Chronic kidney disease |
| url | http://link.springer.com/article/10.1186/s12882-017-0795-z |
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