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Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Cardiovascular risk assessment prior to kidney transplantation
Insights
Identifying risk factors for coronary artery disease (CAD) in patients undergoing dialysis before kidney transplantation (KTx) can streamline care. This study highlights type 2 diabetes and mineral bone disease as key indicators for higher cardiovascular risk.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Cardiovascular diseases (CVD) are the leading cause of mortality in patients undergoing dialysis.
- Coronary artery disease (CAD) risk assessment is crucial before kidney transplantation (KTx).
Purpose of the Study:
- To identify risk factors for CAD in patients on dialysis awaiting KTx.
- To optimize the use of selective coronarography (SCG) and reduce unnecessary non-invasive testing.
- To facilitate faster inclusion on the waiting list for eligible patients.
Main Methods:
- Retrospective analysis of 55 patients undergoing SCG before KTx.
- Patients categorized based on SCG results: negative (n=40) or positive (n=15).
- Statistical analysis to identify predictors of significant coronary stenosis.
Main Results:
- Lower incidence of diabetic nephropathy, ischemic heart disease, and CAD in patients without percutaneous coronary intervention (PCI).
- Significant coronary stenosis correlated with a history of stroke.
- Predictors for PCI included type 2 diabetes mellitus, low high-density lipoprotein cholesterol, low total calcium, and high phosphate levels.
Conclusions:
- Patients with type 2 diabetes mellitus and poorly managed chronic kidney disease/mineral bone disease represent the highest-risk group for positive SCG findings.
- These findings aid in stratifying cardiovascular risk and guiding decisions for SCG in the pre-transplant dialysis population.
Objectives:
The objective was to find out risk factors indicating the patients directly to selective coronarography (SCG) to avoid unnecessary non-invasive testing and in their absence to asses low cardiovascular risk and faster inclusion on the waiting list.
Background:
Cardiovascular diseases (CVD) are the most frequent cause of death in dialysed patients. The aim of our retrospective analysis was to identify risk factors for coronary artery disease (CAD) before kidney transplantation (KTx).
Methods:
Our retrospective analysis consisted of 55 dialysed patients (46 males, 9 females, p < 0.0001), undergoing SCG before KTx. We divided the patients according to SCG results (negative, n = 40, positive finding, n = 15).
Results:
We confirmed a significantly lower incidence of diabetic nephropathy (p = 0.0484), ischaemic heart disease (p = 0.0174) and CAD (p = 0.0001) in patients without percutaneous coronary intervention (PCI; negative finding). Haemodynamically significant coronary stenosis correlated with the occurrence of stroke in a patient's history (p = 0.0104). We identified predictors for performing PCI (positive result): type 2 diabetes mellitus (DM) (p = 0.0472), high-density lipoprotein cholesterol ≤ 1.03 mmol/l (p = 0.0359), total calcium level ≤ 2 mmol/l (p = 0.0309), phosphate level ≥ 1.45 mmol/l (OR 0.2034; p = 0.0351).
Conclusion:
In our analysis, patients with DM and poorly managed chronic kidney disease/mineral bone disease were the riskiest subset of the patients with a positive SCG finding (Tab. 4, Fig. 2, Ref. 30). Text in PDF www.elis.sk Keywords: kidney transplantation, coronary artery disease, selective coronarography, cardiovascular risk.
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