Division of Nephrology, Stanford University School of Medicine, Palo Alto, California.
Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California.
Kidney360. 2021 Dec 9;3(3):516-523. doi: 10.34067/KID.0005282021. eCollection 2022 Mar 31.
Coronary artery disease (CAD) screening in asymptomatic kidney transplant candidates is widespread but not well supported by contemporary cardiology literature. In this study we describe temporal trends in CAD screening before kidney transplant in the United States.
Using the United States Renal Data System, we examined Medicare-insured adults who received a first kidney transplant from 2000 through 2015. We stratified analysis on the basis of whether the patient's comorbidity burden met guideline definitions of high risk for CAD. We examined temporal trends in nonurgent CAD tests within the year before transplant and the composite of death and nonfatal myocardial infarction in the 30 days after transplant.
Of 94,832 kidney transplant recipients, 37,139 (39%) underwent at least one nonurgent CAD test in the 1 year before transplant. From 2000 to 2015, the transplant program waitlist volume had increased as transplant volume stayed constant, whereas patients in the later eras had a slightly higher comorbidity burden (older, longer dialysis vintage, and a higher prevalence of diabetes mellitus and CAD). The likelihood of CAD test in the year before transplant increased from 2000 through 2003 and remained relatively stable thereafter. When stratified by CAD risk status, test rates decreased modestly in patients who were high risk but remained constant in patients who were low risk after 2008. Death or nonfatal myocardial infarction within 30 days after transplant decreased from 3% in 2000 to 2% in 2015. Nuclear perfusion scan was the most frequent modality of testing throughout the examined time periods.
CAD testing rates before kidney transplantation have remained constant from 2000 through 2015, despite widespread changes in cardiology guidelines and practice.
在无症状的肾移植候选者中进行冠状动脉疾病（CAD）筛查已经很普遍，但在当代心脏病学文献中并没有得到很好的支持。在这项研究中，我们描述了美国肾移植前 CAD 筛查的时间趋势。
我们使用美国肾脏数据系统，研究了 2000 年至 2015 年期间接受首次肾移植的医疗保险受保成年人。我们根据患者的合并症负担是否符合 CAD 高危的指南定义对分析进行分层。我们检查了移植前一年内非紧急 CAD 检测的时间趋势以及移植后 30 天内死亡和非致死性心肌梗死的复合结果。
在 94832 名肾移植受者中，37139 名（39%）在移植前 1 年内至少进行了一次非紧急 CAD 检测。从 2000 年到 2015 年，尽管移植量保持不变，但移植项目候补名单的数量增加了，而后期患者的合并症负担略高（年龄较大，透析时间较长，糖尿病和 CAD 的患病率较高）。在移植前一年进行 CAD 检测的可能性从 2000 年至 2003 年增加，此后相对稳定。按 CAD 风险状况分层，高风险患者的检测率略有下降，但 2008 年后低风险患者的检测率保持不变。移植后 30 天内死亡或非致死性心肌梗死的发生率从 2000 年的 3%下降到 2015 年的 2%。在整个研究期间，核素灌注扫描一直是最常见的检测方式。
尽管心脏病学指南和实践发生了广泛变化，但 2000 年至 2015 年期间，肾移植前的 CAD 检测率保持不变。
