Related Experiment Video
Updated: Jul 8, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
External Validation of Proposed American Heart Association Algorithm for Cardiovascular Screening Before Kidney
Marie Bodilsen Nielsen1,2, Jonathan Nørtoft Dahl3,4, Bente Jespersen2,4
1Department of Biomedicine Aarhus University Aarhus Denmark.
Insights
The AHA-2022 algorithm identifies more kidney transplant candidates needing cardiovascular screening than AHA-2012. This updated guideline effectively stratifies patients by risk for major adverse cardiovascular events and death.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Cardiovascular disease screening is recommended before kidney transplantation.
- The study evaluates the American Heart Association's 2022 (AHA-2022) algorithm for cardiovascular screening in kidney transplant candidates.
- Comparison is made between AHA-2022 and the prior AHA-2012 recommendation.
Purpose of the Study:
- To validate the AHA-2022 algorithm's effectiveness in identifying cardiovascular risk in kidney transplant candidates.
- To compare patient allocation and outcomes between AHA-2022 and AHA-2012 screening protocols.
Main Methods:
- An observational cohort of 529 kidney transplant candidates was analyzed.
- Candidates underwent extensive coronary heart disease screening via cardiac computed tomography.
- Algorithms (AHA-2022 and AHA-2012) were applied to categorize patients into risk groups.
Main Results:
- The AHA-2022 algorithm recommended cardiology referral or screening for 73% of patients, versus 53% with AHA-2012 (P<0.0001).
- Patients recommended for referral/screening by AHA-2022 showed higher risks of major adverse cardiovascular events and all-cause death.
- Revascularization rates post-screening were significantly higher in patients identified for referral/screening.
Conclusions:
- The AHA-2022 algorithm identifies a greater proportion of kidney transplant candidates requiring cardiac referral and screening.
- AHA-2022 effectively stratifies candidates into high, intermediate, and low risk categories for cardiovascular events and mortality.
- This updated algorithm improves risk discrimination for better pre-transplant cardiovascular management.
Background:
Screening for cardiovascular disease is currently recommended before kidney transplantation. The present study aimed to validate the proposed algorithm by the American Heart Association (AHA-2022) considering cardiovascular findings and outcomes in kidney transplant candidates, and to compare AHA-2022 with the previous recommendation (AHA-2012).
Methods And Results:
We applied the 2 screening algorithms to an observational cohort of kidney transplant candidates (n=529) who were already extensively screened for coronary heart disease by referral to cardiac computed tomography between 2014 and 2019. The cohort was divided into 3 groups as per the AHA-2022 algorithm, or into 2 groups as per AHA-2012. Outcomes were degree of coronary heart disease, revascularization rate following screening, major adverse cardiovascular events, and all-cause death. Using the AHA-2022 algorithm, 69 (13%) patients were recommended for cardiology referral, 315 (60%) for cardiac screening, and 145 (27%) no further screening. More patients were recommended cardiology referral or screening compared with the AHA-2012 (73% versus 53%; P<0.0001). Patients recommended cardiology referral or cardiac screening had a higher risk of major adverse cardiovascular events (hazard ratio [HR], 5.5 [95% CI, 2.8-10.8]; and HR, 2.1 [95% CI, 1.2-3.9]) and all-cause death (HR, 12.0 [95% [CI, 4.6-31.4]; and HR, 5.3 [95% CI, 2.1-13.3]) compared with patients recommended no further screening, and were more often revascularized following initial screening (20% versus 7% versus 0.7%; P<0.001).
Conclusions:
The AHA-2022 algorithm allocates more patients for cardiac referral and screening compared with AHA-2012. Furthermore, the AHA-2022 algorithm effectively discriminates between kidney transplant candidates at high, intermediate, and low risk with respect to major adverse cardiovascular events and all-cause death.
