Introduction and objective: Current guidelines recommend screening for coronary artery disease (CAD) in kidney transplantation (KT) candidates, but the supporting evidence is limited and outdated. This often leads to an accumulation of additional tests that delay the graft reception. In this context, our objective was to evaluate the pharmacological control of classic cardiovascular risk factors (CVRF) in these patients, based on the premise that effective pharmacological optimisation should precede any complex diagnostic approach.
Materials and methods: This is an observational, analytical and retrospective study of adult patients who underwent a KT in our autonomous community between January 2020 and December 2022. The criteria for performing advanced cardiological studies included the presence of multiple CVRF, diabetes mellitus (DM), angina-like symptoms or history of CAD. The patients’ usual treatments were recorded based on the hospital admission report.
Results: 156 patients underwent KT, 73% of whom were men, with a mean age of 57 years. Table 1 shows the population profile and the cardiological studies performed before transplantation. The execution of these advanced complementary tests resulted in a delay of 11 months in receiving the transplant. Table 2 presents some laboratory values prior to KT and the usual pharmacological treatment of these patients. Among diabetic patients for whom laboratory data were available, 55% were not within target ranges for HbA1c, and none received sodium-glucose co-transporter 2 inhibitors (SGLT2i). The established LDL cholesterol target of <55 mg/dl was achieved in a minority (25%), indicating significant optimisation margin in lipid-lowering therapy.
Conclusion: A high proportion of patients (53%) undergo advanced cardiological studies prior to kidney transplantation, despite suboptimal baseline control of classic cardiovascular risk factors. The risk-benefit balance of these procedures should be carefully evaluated, as they increase the time on renal replacement therapy (RRT) by nearly a year, with the associated rise in mortality and the real opportunity for prior medical optimisation. The current evidence to pre-transplant cardiac evaluation may need to be reconsidered, with greater emphasis on pharmacological measures.
