Prevalence of cardiovascular disease in kidney transplant candidates: outpatient cardiac evaluation.
BACKGROUND
Cardiovascular disease is the most common cause of death after kidney transplantation. Pretransplant cardiovascular screening is an integral part of the assessment of patients with end-stage renal disease in most transplantation centers. Through this descriptive study we sought to highlight the major cardiovascular diseases that cause the high mortality rate before and after renal transplantation.


METHODS
Between November 2005 and December 2009 we screened 356 patients for cardiovascular disease before inclusion in the renal transplant waiting list. All candidates underwent an analytical study, chest radiography, electrocardiogram, and echocardiography, as well as coronary angiography in high-risk patients.


RESULTS
Clinical evaluations were performed in 356 patients (63% men) of mean age 54.3±11 years. They had been on renal replacement treatment for a median 13.2 months. Risk factors included hypertension (95.8%), dyslipidemia (56.5%), smoking (53.4%), and diabetes (27.2%). Cardiovascular disease included peripheral artery disease (15%), coronary artery disease (CAD; 12.1%), and stroke (9.8%). Significant CAD was found in 89 individuals (38.4%), 73 (82%) of whom were asymptomatic. Peripheral artery disease (P=.02), high levels of total cholesterol (P=.03), triglycerides (P=.03), and C-reactive protein (P=.03) were associated with the presence of severe CAD. The main diagnoses were hypertensive heart disease (70.8%), ischemic heart disease (33.1%), aortic valve disease (24.4%), and mitral valve disease (30.1%).


CONCLUSIONS
Patients with chronic kidney disease show a high prevalence of cardiovascular risk factors and ischemic heart disease, principally occult coronary artery stenosis, which could explain their high cardiovascular mortality after renal transplantation.
Department of Cardiology, Virgen del Rocio University Hospital, Seville, Spain.
J D Arjona
JD
Barrionuevo
M F Gonzáles
MF
Vargas-Machuca
F Gómez
FG
Pulido
L Gil
LG
Sacaluga
M A Gentil
MA
Govantes
A
A
Martínez Martínez
D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015995:Prevalence