Cardiovascular Disease Assessment Prior to Kidney Transplantation

Cardiovascular disease is highly prevalent and the leading cause of mortality in patients with chronic kidney disease, end-stage kidney disease, and kidney transplantation. However, kidney transplantation offers improved survival and quality of life, with an overall reduction in cardiovascular disea...

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Main Authors: Angelina R. Edwards, Elise C. Ewing
Format: Article
Language:English
Published: Houston Methodist DeBakey Heart & Vascular Center 2022-09-01
Series:Methodist DeBakey Cardiovascular Journal
Subjects:
Online Access:https://account.journal.houstonmethodist.org/index.php/up-j-mdbcj/article/view/1117
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author Angelina R. Edwards
Elise C. Ewing
author_facet Angelina R. Edwards
Elise C. Ewing
author_sort Angelina R. Edwards
collection DOAJ
description Cardiovascular disease is highly prevalent and the leading cause of mortality in patients with chronic kidney disease, end-stage kidney disease, and kidney transplantation. However, kidney transplantation offers improved survival and quality of life, with an overall reduction in cardiovascular disease events; therefore, it remains the optimal treatment choice for those with advanced kidney disease. Pretransplantation cardiovascular assessment is performed prior to wait-listing and at routine intervals with the principal goal of screening for asymptomatic cardiac disease, intervening when necessary to improve long-term patient and allograft survival. Current clinical practice guidelines are based on expert opinion, with a lack of high-quality evidence to guide standardized screening practices. Recent studies support de-escalation in screening with avoidance of preemptive revascularization in asymptomatic patients, but they fail to provide clear guidance on how best to assess the cardiovascular fitness of this high-risk group. Herein we summarize current practice guidelines, discuss key study findings, highlight the role of optimal medical therapy, and evaluate future directions for cardiovascular disease assessment in this population.
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spelling doaj-art-50bb598a4c0743069bb33dae4b2079fd2025-08-20T03:25:50ZengHouston Methodist DeBakey Heart & Vascular CenterMethodist DeBakey Cardiovascular Journal1947-61082022-09-01184506110.14797/mdcvj.11171135Cardiovascular Disease Assessment Prior to Kidney TransplantationAngelina R. Edwards0https://orcid.org/0000-0003-4609-2388Elise C. Ewing1https://orcid.org/0000-0001-6500-2072Division of Renal Diseases and Hypertension, Houston Methodist Hospital, Houston, Texas; Texas A&M College of Medicine, Houston, TexasDivision of Renal Diseases and Hypertension, Houston Methodist Hospital, Houston, TexasCardiovascular disease is highly prevalent and the leading cause of mortality in patients with chronic kidney disease, end-stage kidney disease, and kidney transplantation. However, kidney transplantation offers improved survival and quality of life, with an overall reduction in cardiovascular disease events; therefore, it remains the optimal treatment choice for those with advanced kidney disease. Pretransplantation cardiovascular assessment is performed prior to wait-listing and at routine intervals with the principal goal of screening for asymptomatic cardiac disease, intervening when necessary to improve long-term patient and allograft survival. Current clinical practice guidelines are based on expert opinion, with a lack of high-quality evidence to guide standardized screening practices. Recent studies support de-escalation in screening with avoidance of preemptive revascularization in asymptomatic patients, but they fail to provide clear guidance on how best to assess the cardiovascular fitness of this high-risk group. Herein we summarize current practice guidelines, discuss key study findings, highlight the role of optimal medical therapy, and evaluate future directions for cardiovascular disease assessment in this population.https://account.journal.houstonmethodist.org/index.php/up-j-mdbcj/article/view/1117cardiovascular screeningkidney transplantationchronic kidney diseaseend stage kidney disease
spellingShingle Angelina R. Edwards
Elise C. Ewing
Cardiovascular Disease Assessment Prior to Kidney Transplantation
Methodist DeBakey Cardiovascular Journal
cardiovascular screening
kidney transplantation
chronic kidney disease
end stage kidney disease
title Cardiovascular Disease Assessment Prior to Kidney Transplantation
title_full Cardiovascular Disease Assessment Prior to Kidney Transplantation
title_fullStr Cardiovascular Disease Assessment Prior to Kidney Transplantation
title_full_unstemmed Cardiovascular Disease Assessment Prior to Kidney Transplantation
title_short Cardiovascular Disease Assessment Prior to Kidney Transplantation
title_sort cardiovascular disease assessment prior to kidney transplantation
topic cardiovascular screening
kidney transplantation
chronic kidney disease
end stage kidney disease
url https://account.journal.houstonmethodist.org/index.php/up-j-mdbcj/article/view/1117
work_keys_str_mv AT angelinaredwards cardiovasculardiseaseassessmentpriortokidneytransplantation
AT elisecewing cardiovasculardiseaseassessmentpriortokidneytransplantation