title: Cardiovascular Screening and Management Among Kidney Transplant Candidates in Hungary.
abstract: BACKGROUND
  Cardiovascular disease is a major cause of morbidity and mortality in end-stage renal disease patients on dialysis and the most common cause of death in the immediate post-transplantation period. The aim of our study was to describe a novel approach of cardiovascular screening and management of dialysis patients evaluated for the transplant waiting list.
  
  
  METHODS
  Twenty-eight patients with end-stage renal disease put on the waiting list between July 2013 and July 2014 were subjected to a prespecified cardiovascular screening protocol utilizing noninvasive and/or invasive tests. Patients were subsequently divided into 3 strata in terms of their estimated cardiovascular risk. Each of these groups were then prescribed interventions aiming to improve their cardiovascular condition.
  
  
  RESULTS
  According to our prespecified protocol of cardiovascular screening studies, 15 (54%) patients were identified as low, 5 (18%) as intermediate, and 8 (28%) as high risk. Four (14%) patients were current smokers. In the low-risk group, we initiated a patient education program involving counseling on regular exercise such as swimming or cycling to improve their functional capacity. In the high-risk group revascularization was done in 5 cases (63%), including 3 percutaneous transluminal coronary angioplasties (PTCA) with stents for single-vessel disease, and coronary artery bypass graft surgeries (CABG) for triple-vessel disease in 2 cases. In the medium-risk group medical management was opted for, including introduction of beta-blockers, inhibitors, statins, and ezetimibe, as well as efforts to optimize anemia management, indices of bone-mineral disease, and fluid status.
  
  
  CONCLUSIONS
  In our regional transplant program, we introduced a comprehensive multidisciplinary approach to treat potential transplant candidates according to cardiovascular risk stratification based on a prespecified screening protocol. Further studies are needed to correlate this novel strategy with post-transplantation outcomes.
authors.affiliation: FMC Debrecen, Extracorporal Organsupport Centre, University of Debrecen, Debrecen, Hungary; Institute of Surgery, Division of Transplantation, University of Debrecen, Debrecen, Hungary. Electronic address: rpszabo@belklinika.com.
authors.forename: R P
authors.initials: RP
authors.lastname: Szabó
authors.affiliation: Institute of Cardiology, University of Debrecen, Debrecen, Hungary.
authors.forename: I
authors.initials: I
authors.lastname: Varga
authors.affiliation: FMC Debrecen, Extracorporal Organsupport Centre, University of Debrecen, Debrecen, Hungary; 1st Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
authors.forename: J
authors.initials: J
authors.lastname: Balla
authors.affiliation: Institute of Surgery, Division of Transplantation, University of Debrecen, Debrecen, Hungary.
authors.forename: L
authors.initials: L
authors.lastname: Zsom
authors.affiliation: Institute of Surgery, Division of Transplantation, University of Debrecen, Debrecen, Hungary.
authors.forename: B
authors.initials: B
authors.lastname: Nemes
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000628:therapy; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D006814:Hungary; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D006435:Renal Dialysis; D012307:Risk Factors; D014850:Waiting Lists