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Performance versus Risk Factor-Based Approaches to Coronary Artery Disease Screening in Waitlisted Kidney Transplant
Xingxing S Cheng1, Daniel J Watford1, Hiroyuki Arashi2,3
1Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Cardiorenal Medicine
|May 25, 2021
Summary
The 6-minute walk test (6MWT) identifies fewer kidney transplant candidates as high-risk for coronary artery disease (CAD) compared to traditional methods. However, its effectiveness is influenced by waitlist dynamics, suggesting tailored screening is crucial.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Current coronary artery disease (CAD) screening before kidney transplantation is often inefficient, leading to numerous tests with limited interventions.
- Risk stratification for CAD in kidney transplant candidates is critical to optimize outcomes.
Purpose of the Study:
- To evaluate the utility of the 6-minute walk test (6MWT) for cardiorespiratory fitness and risk stratification in kidney transplant candidates.
- To compare the 6MWT-based approach with traditional risk factor and symptom-based screening methods for CAD.
Main Methods:
- 360 kidney transplant waitlist patients underwent CAD evaluation and 6MWT.
- Association between 6MWT performance and time to CAD-related events (cardiac death, revascularization, myocardial infarction, waitlist removal for CAD) was analyzed.
- Competing risks of non-cardiac death and non-CAD waitlist removal were considered.
Main Results:
- The 6MWT approach classified 45% of patients as low risk, contrasting with 14% (risk factor-based) and 81% (symptom-based).
- Within 1 year, 6MWT was not significantly associated with CAD events but was linked to competing events.
- Excluding waitlist status, 6MWT performance correlated with CAD event development.
Conclusions:
- The 6MWT identifies fewer patients requiring further CAD testing compared to risk factor-based methods.
- The 6MWT's utility for CAD risk stratification is moderated by waitlist removal rates.
- Pre-transplant CAD screening should be individualized based on a patient's likelihood of receiving a transplant.
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