HDCN Abstract:  ASN Annual Meeting -- San Francisco  

Lentine K, Schnitzler M, Brennan D, et al.

Does Cardiac Evaluation Delay Kidney Transplantation in Lower Risk Dialysis Patients?

ASN Annual Meeting -- San Francisco
J Am Soc Nephrol (Nov) 18:712A 2007

Recent studies challenge the value of invasive interventions for stable coronary artery disease in the general population. Among kidney transplant (KTX) candidates, effectiveness of cardiac screening is controversial. We retrospectively investigated associations of cardiac evaluations (CE) with time to KTX and mortality among dialysis patients.

We examined US Renal Data System records for patients who achieved access to the deceased donor wait list or live donor transplant in 1991-2002, received Medicare- insured dialysis for > 6mo and maintained Medicare through KTX access. Patients were stratified as high risk (age > 50, diabetes or known cardiovascular disease; n=10,835) vs lower risk (n=6,673) at ESRD onset. CE were defined by billing claims for coronary angiography, stress echocardiography, myocardial perfusion study or exercise treadmill submitted between 1st ESRD service and earliest of listing or KTX.

Assuming decision to evaluate for KTX as a baseline factor at ESRD, incidence of KTX did not vary by CE status in high risk patients. However, times to live donor and total KTX were longer in lower risk patients who underwent CE. Survival was also inferior in lower risk patients who received CE.



Association of CE with increased mortality in the lower risk group persisted in multivariable regression and with case-matching for predicted probability of CE.

Among dialysis patients at lower baseline risk according to criteria commonly used in screening decisions, time to KTXs were longer in those who underwent CE. While these associations cannot prove causation, the data support need for prospective evaluation pre-KTX cardiac screening practices in relation to timeliness of KTX access in lower risk patients.

© Copyright 2007-2008, American Society of Nephrology. Reproduced with permission.
Until September of 2008, all ASN abstracts from the 2007 Annual Meeting are available at this link.

Disclaimer: Abstracts often have errors, both typographical and otherwise. This posting is an electronic translation of submitted abstracts which has not been verified against the original submitted abstract nor with the authors for accuracy. As a result, there may be errors, especially with regard to drug doses, but not limited to these. Abstracts undergo only limited review, and data often are changed as a result of the peer review process, so their reliability is less than manuscripts published in peer-reviewed journals. In using these summaries, you are agreeing that you are aware of these limitations.

The materials are provided on an as-is basis without any warranty of any kind, either express or implied. In addition to errors, the information presented may be incomplete or outdated. The information contained is not intended nor recommended as a substitute for professional medical advice. You are advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each device to be used or drug to be administered to verify the dosage, the method and duration of administration, or contraindications. It is the responsibility of the treating physician or other health care professional, relying on independent experience and knowledge of the patient, to determine drug, disease, and the best treatment for the patient.

To the fullest extent permitted by law, HDCN, ASN and their affiliates and suppliers disclaim all warranties, express or implied, including, but not limited to, any warranty of merchantability, non- infringement or fitness for a particular purpose.

In no event shall HDCN, ASN, or their affiliates or suppliers be liable for any damages whatsoever (including, but not limited to, direct, indirect, incidental, consequential, punitive or exemplary damages, or any damages for loss of profits, use, data, goodwill or other intangibles) arising from or in any way relating to these terms, the materials, or any information, goods or services obtained from or referred to in the materials, whether based on warranty, contract, tort (including, but not limited to, negligence), or any other legal theory, and whether or not any or all of the limited entities is advised of the possibility of such damages.