Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
Department of Cardiology, Kaiser Permanente Riverside Medical Center, Riverside, California, USA.
Open Heart. 2024 Sep 13;11(2):e002738. doi: 10.1136/openhrt-2024-002738.
Routine screening for cardiovascular disease before kidney transplantation remains controversial. This study aims to compare cardiac testing rates in patients with end-stage renal disease, referred and not referred for transplantation, and assess the impact of testing on transplant wait times.
This is a retrospective cohort study of 22 687 end-stage renal disease patients from 2011 to 2022, within an integrated health system. Cardiac testing patterns, and the association between cardiac testing and transplant wait times and post-transplant mortality were evaluated.
Of 22 687 patients (median age 66 years, 41.1% female), 6.9% received kidney transplants, and 21.0% underwent evaluation. Compared with dialysis patients, transplant patients had a 5.6 times higher rate of stress nuclear myocardial perfusion imaging with single-photon emission (rate ratio (RR) 5.64, 95% CI 5.37 to 5.92), a 6.5 times higher rate of stress echocardiogram (RR 6.51, 95% CI 5.65 to 7.51) and 16% higher cardiac catheterisation (RR 1.16, 95% CI 1.06 to 1.27). In contrast, revascularisation rates were significantly lower in transplant patients (RR 0.46, 95% CI 0.36 to 0.58). Transplant wait times were longer for patients who underwent stress testing (median 474 days with no testing vs 1053 days with testing) and revascularisation (1796 days for percutaneous intervention and 2164 days for coronary artery bypass surgery). No significant association was observed with 1-year post-transplant mortality (adjusted OR 1.99, 95% CI 0.46 to 8.56).
This study found a higher rate of cardiac testing in dialysis patients evaluated for kidney transplants. Cardiac testing was associated with longer transplant wait time, but no association was observed between testing and post-transplant mortality.
在肾移植前进行心血管疾病常规筛查仍存在争议。本研究旨在比较终末期肾病患者中接受和未接受移植转诊患者的心脏检测率，并评估检测对移植等待时间的影响。
这是一项回顾性队列研究，纳入了 2011 年至 2022 年间一个综合医疗系统内的 22687 例终末期肾病患者。评估了心脏检测模式，以及心脏检测与移植等待时间和移植后死亡率之间的关系。
在 22687 例患者中（中位年龄 66 岁，41.1%为女性），6.9%接受了肾移植，21.0%接受了评估。与透析患者相比，移植患者接受单光子发射断层扫描（SPECT）应激核素心肌灌注成像的比例高 5.6 倍（率比（RR）5.64，95%置信区间（CI）5.37 至 5.92），接受应激超声心动图的比例高 6.5 倍（RR 6.51，95%CI 5.65 至 7.51），接受心导管检查的比例高 16%（RR 1.16，95%CI 1.06 至 1.27）。相反，移植患者的血运重建率明显较低（RR 0.46，95%CI 0.36 至 0.58）。接受检查的患者等待移植的时间较长（无检查的中位数为 474 天，有检查的中位数为 1053 天），接受血运重建的患者等待时间也较长（经皮介入治疗的中位数为 1796 天，冠状动脉旁路移植术的中位数为 2164 天）。未观察到 1 年移植后死亡率与检查有显著关联（校正比值比（OR）1.99，95%CI 0.46 至 8.56）。
本研究发现，在接受肾移植评估的透析患者中，心脏检测率更高。心脏检测与移植等待时间延长有关，但与移植后死亡率之间无关联。
