Approach to the evaluation for coronary artery disease in kidney transplant candidates

CAD: coronary artery disease.

* Clinical practice among transplant centers varies, and some centers obtain noninvasive stress testing in all kidney transplant candidates regardless of the presence or absence of risk factors.

¶ Noninvasive stress testing can be performed with a dobutamine stress echocardiogram, myocardial perfusion study, or coronary computed tomography angiography. The optimal choice is generally based upon the expertise of the particular medical center and clinical patient characteristics.

Δ Some experts would obtain stress testing for transplant candidates <45 years old who do not have diabetes or a prior history of CAD if they have a prolonged duration of chronic kidney disease, dialysis vintage >1 year, a history of uncontrolled hypertension, or family history of heart disease.

◊ For patients on dialysis who are found to have a reduced ejection fraction, some clinicians would first review the patient's dialysis records to make sure that the patient has been adequately dialyzed to their dry weight with acceptable interdialytic weight gain.