Navigating the complexities: an updated framework for cardiovascular risk stratification in transplantation...

Area of Science:

• Nephrology
• Cardiology
• Transplantation Medicine

Background:

• End-stage kidney disease (ESKD) management often involves kidney transplantation, superior to other renal replacement therapies.
• Prolonged dialysis treatment increases risks of cardiovascular and systemic complications in ESKD patients.
• ESKD patients awaiting transplantation frequently present with comorbidities like coronary artery disease, peripheral arterial disease, hypertension, and diabetes mellitus.

Purpose of the Study:

• To review current evidence on cardiovascular disease (CVD) in ESKD patients considered for kidney transplantation.
• To propose a practical, phased strategy for assessing and optimizing cardiovascular risk before kidney transplantation.

Main Methods:

• This study is a narrative review.
• Recent scientific literature on CVD in ESKD transplant candidates was synthesized.
• A stepwise approach for pre-transplant cardiovascular risk management was developed.

Main Results:

• ESKD patients awaiting kidney transplantation often have significant cardiovascular disease burdens.
• A structured approach to cardiovascular risk assessment is necessary for this population.
• Optimization of cardiovascular health pre-transplant can improve outcomes.

Conclusions:

• Kidney transplantation is the preferred treatment for ESKD, but requires careful patient preparation.
• Addressing cardiovascular risks is paramount for successful kidney transplantation in patients with prolonged dialysis.
• A systematic pre-transplant cardiovascular evaluation and management plan is essential.