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Published on: April 28, 2013
The effect of coronary angiography on renal function in preemptive renal transplant candidates
Elizabeth C Lorenz1, Mark D Stegall, Fernando G Cosio
1Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Cardiac catheterization does not hasten dialysis needs in preemptive renal transplant candidates. This study found no impact on the timing or necessity of dialysis, supporting its use for cardiac evaluation.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Preemptive renal transplantation is increasing.
- Cardiac catheterization before transplantation is debated due to contrast nephropathy risks.
- The impact on dialysis timing in transplant candidates is unclear.
Purpose of the Study:
- To evaluate the effect of cardiac catheterization on the need for dialysis in preemptive renal transplant candidates.
- To assess the risk of contrast nephropathy and dialysis initiation after angiography.
Main Methods:
- Retrospective review of 376 preemptive renal transplant candidates (2/2001-4/2005).
- Analysis of 34 patients with positive dobutamine stress echocardiograms.
- Comparison of dialysis initiation between patients who underwent angiography and those who did not.
Main Results:
- 8.7% of candidates requiring angiography needed dialysis within 14 days of contrast.
- 26% of those undergoing angiography eventually needed dialysis before transplant (5.3 months post-evaluation).
- 27% of those not undergoing angiography needed dialysis before transplant (2.4 months post-evaluation).
Conclusions:
- Cardiac catheterization poses a low risk of hastening dialysis in preemptive renal transplant candidates.
- Angiography did not influence the ultimate need for or timing of dialysis initiation.
- Full cardiac evaluation, including angiography, is supported for high-risk candidates.
Background:
Increasing numbers of patients undergo preemptive renal transplantation. Obtaining cardiac catheterizations prior to transplantation to screen for coronary artery disease is controversial because of the perceived risk of inducing contrast nephropathy and the need for dialysis in patients with marginal renal function. We sought to examine the true impact of cardiac catheterization on time to dialysis in a cohort of preemptive renal transplant candidates.
Methods:
From a cohort of 376 transplant candidates evaluated preemptively at our program between 2/2001 and 4/2005, 34 patients had positive dobutamine stress echocardiograms. We reviewed the subsequent need for dialysis in these patients.
Results:
Among candidates undergoing angiography, 8.7% required dialysis within 14 d of contrast administration and 26% eventually needed dialysis prior to transplantation at 5.3 ± 3.7 months after their pre-transplant evaluation. Among patients who did not undergo angiography, 27% needed dialysis prior to transplantation at 2.4 ± 1.8 months after pre-transplant evaluation.
Conclusions:
Our results demonstrate a low risk of hastening the need for dialysis after coronary angiography in preemptive renal transplant candidates. Undergoing angiography had no effect on the ultimate need for or timing of dialysis initiation. These findings support completion of full cardiac evaluation as indicated for high-risk preemptive renal transplant candidates.
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