Effect of elective coronary angiography on glomerular filtration rate in patients with advanced chronic kidney disease.
OBJECTIVE
Preemptive transplantation is ideal for patients with advanced chronic kidney disease (CKD). The practice has been to perform coronary angiography (CA) on all patients aged >50, all diabetics, and all patients with cardiac symptoms or disease with a view to revascularization before transplantation. Historically patients have delayed CA until established on renal replacement therapy due to concerns of precipitating the need for chronic dialysis. The objectives of this study were to establish the risk of contrast nephropathy in patients with advanced CKD who undergo screening CA, and to determine whether or not preemptive transplantation is achievable.


METHODS
This retrospective analysis included 482 patients with stage IV/V CKD seen in West London predialysis clinics from 2004 to 2007. Seventy-six of 482 (15.8%) patients considered as potential transplant recipients met the authors' criteria for coronary angiography. Modification of Diet in Renal Disease (MDRD) GFR measurements were recorded for the 12 mo preceding and 12 mo following CA unless a defined endpoint was reached (transplantation, dialysis, or death).


RESULTS
Mean MDRD GFR at CA was 12.51 +/- 3.51 ml/min. The trend was not significantly different 6 mo pre- and postangiography. Cumulative dialysis-free survival was 89.1% 6 mo postangiography. Twenty-three of 76 (30.3%) patients had flow-limiting coronary artery disease. Twenty-five of 76 (32.9%) patients underwent transplantation with 22 of 25 (88.0%) transplants being performed preemptively.


CONCLUSIONS
The data suggest CA screening does not accelerate the decline in renal function for patients with advanced CKD, facilitating a safe preemptive transplant program.
Kumar
Nicola
N
Department of Renal and Transplantation Medicine, West London Renal and Transplant Center, Imperial College Kidney and Transplant Institute, Du Cane Road, London, UK. nicky.kumar@imperial.nhs.uk
Dahri
Lynn
L
Brown
Wendy
W
Duncan
Neill
N
Singh
Seema
S
Baker
Christopher
C
Malik
Iqbal
I
Palmer
Andrew
A
Griffith
Megan
M
Cairns
Tom
T
Taube
David
D
D000368:Aged; D017023:Coronary Angiography / Q000009:adverse effects / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000009:adverse effects / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000178:diet therapy / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014850:Waiting Lists
D003404:Creatinine