Cardiovascular Disease Assessment Prior to Kidney Transplantation.
Angelina R EdwardsAngelina R EdwardsPublished in: Methodist DeBakey cardiovascular journal (2022)
Cardiovascular disease is highly prevalent and the leading cause of mortality in patients with chronic kidney disease, end-stage kidney disease, and kidney transplantation. However, kidney transplantation offers improved survival and quality of life, with an overall reduction in cardiovascular disease events; therefore, it remains the optimal treatment choice for those with advanced kidney disease. Pretransplantation cardiovascular assessment is performed prior to wait-listing and at routine intervals with the principal goal of screening for asymptomatic cardiac disease, intervening when necessary to improve long-term patient and allograft survival. Current clinical practice guidelines are based on expert opinion, with a lack of high-quality evidence to guide standardized screening practices. Recent studies support de-escalation in screening with avoidance of preemptive revascularization in asymptomatic patients, but they fail to provide clear guidance on how best to assess the cardiovascular fitness of this high-risk group. Herein we summarize current practice guidelines, discuss key study findings, highlight the role of optimal medical therapy, and evaluate future directions for cardiovascular disease assessment in this population.
Keyphrases
- kidney transplantation
- cardiovascular disease
- cardiovascular events
- healthcare
- type diabetes
- primary care
- clinical practice
- end stage renal disease
- ejection fraction
- chronic kidney disease
- physical activity
- newly diagnosed
- body composition
- randomized controlled trial
- stem cells
- percutaneous coronary intervention
- prognostic factors
- heart failure
- open label
- coronary artery disease
- metabolic syndrome
- acute coronary syndrome
- quality improvement
- combination therapy
- postoperative pain