Diagnosis and treatment of coronary artery disease in hemodialysis patients evaluated for transplant

Compared to the general population, patients with chronic kidney disease (CKD) are at the highest risk of developing cardiovascular complications and dying [1]. This trend has been observed in individuals with moderate reduction in renal function and increases as renal insufficiency progresses [2]. The adjusted risk of cardiovascular death for patients on dialysis is 10 to 20 times higher than that in the general population, and 50% of such deaths are related to coronary artery disease (CAD) [3,4]. Also, patients with CKD have a worse prognosis once one event has occurred [5], thus most patients with CKD are more likely to die as a result of cardiovascular disease (CVD) than to reach the final stages of renal failure and be started on renal replacement therapy [6]. The prevalence of significant CAD (>50% stenosis) in dialysis patients varies between 30% and 70% and is greatly influenced by age and the presence of diabetes as well as by the use of angiography as a diagnostic method [7]‐[12]. Renal transplantation is associated with improved survival [13], but CVD remains the most common cause of death after transplantation [14]. Together, these facts justify the routine assessment of patients with CKD for associated CVD and CAD, including those being considered for kidney transplantation.The optimal way to screen for and manage CAD prior to and following kidney transplantation is a topic of intense debate in the literature. There is no firm consensus about who should be tested, which testing modality should be used and who should undergo intervention if CAD is found [15]‐[15-18]. In 1997, our center started a prospective, observational study intended to determine the best clinical and cardiovascular investigations for the detection of CAD and the prediction of cardiovascular events in patients evaluated for kidney transplants. The cohort now encompasses 1,250 patients with a median follow-up of 38？months. The present article is based on the database and data collecte