Screening asymptomatic diabetic patients for coronary artery disease prior to renal transplantation.
BACKGROUND
Coronary artery disease (CAD) is a significant contributor to excess mortality in renal transplant candidates with diabetes mellitus (DM). Prior studies relating to risk stratification for significant CAD in diabetics are confined to Caucasian type 1 DM patients.


METHODS
To assess the prevalence of clinically silent CAD and to identify variables that are associated with CAD, we retrospectively analyzed the cardiac catheterization data of 97 asymptomatic type 1 and 2 DM kidney and kidney-pancreas transplant candidates.


RESULTS
Thirty-three percent of type 1 and 48% of type 2 DM patients had significant stenosis (> or = 70%) in 1 or more coronary arteries. On multivariate logistic regression analysis, body mass index (BMI) >25 was significantly associated with CAD (relative risk = 4.8, P = 0.002). The age of the patient (7% increase in risk/year, P = 0.01; or relative risk = 3.0 if age >47 years, P = 0.032) and smoking history (2% increase in risk/pack-year of smoking, P = 0.10) were also associated with CAD. African American patients, who comprised 30% of the sample, had a 71% lower risk compared with Caucasian patients (P = 0.03). Factors that were not significantly associated with CAD included gender, type of diabetes, and whether dialyzed for >6 months prior to catheterization.


CONCLUSIONS
We conclude that a notable proportion (approximately one-third to one-half) of asymptomatic type 1 and type 2 diabetic renal transplant candidates have significant CAD. Additionally, young African American DM patients with no smoking history and a BMI </=25 are at reduced risk, and invasive tests may not be necessary in this group.
Ramanathan
Venkataraman
V
Division of Nephrology, O'Brien Kidney Research Center, Baylor College of Medicine, Houston 77030, TX, USA. ramanath@bcm.tmc.edu
Goral
Simin
S
Tanriover
Bekir
B
Feurer
Irene D
ID
Kazancioglu
Rumeyza
R
Shaffer
David
D
Helderman
J Harold
JH
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D015992:Body Mass Index; D006328:Cardiac Catheterization; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D048909:Diabetes Complications / Q000208:ethnology / Q000601:surgery; D003922:Diabetes Mellitus, Type 1; D003924:Diabetes Mellitus, Type 2; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000208:ethnology / Q000601:surgery*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016035:Pancreas Transplantation; D010182:Pancreatic Diseases / Q000208:ethnology / Q000601:surgery; D011300:Preoperative Care; D015995:Prevalence; D012189:Retrospective Studies; D044465:White People / Q000706:statistics & numerical data