Trends in coronary artery disease screening before kidney transplantation

Abstract

Background: Coronary artery disease (CAD) screening in asymptomatic kidney transplant candidates is widespread but not well supported by contemporary cardiology literature. We describe here temporal trends in CAD screening before kidney transplant in the United States. Methods: 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 based on whether the patient's comorbidity burden met guideline definitions of high-risk for CAD. We examined temporal trends in non-urgent CAD tests within the year prior to transplant and the composite of death and non-fatal myocardial infarction in the 30 days after transplant. Results: Of 94,832 kidney transplant recipients, 37,139 (39%) underwent at least one non-urgent CAD test in the 1 year prior to transplant. From 2000 to 2015, The transplant program waitlist volume had increased as transplant volume stayed constant, while patients in the later eras had 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 prior to transplant increased from 2000 through 2003 and remained relatively stable thereafter. When stratified by CAD risk status, test rates decreased modestly in high-risk patients but remained constant in low-risk patients after 2008. Death or non-fatal myocardial infarction within 30 days after transplant decreased from 3.4% in 2000 to 1.5% in 2015. Nuclear perfusion scan was the most frequent modality of testing throughout examined time periods. Conclusions: CAD testing rates before kidney transplantation have remained constant from 2000 through 2015 despite widespread changes in cardiology guidelines and practice.