A screening test that measures whether a patient's heart is healthy enough for a kidney transplant is not as dangerous as once thought, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN). The findings indicate that the test, called coronary angiography, does not cause a decline in kidney function for patients with advanced chronic kidney disease (CKD) and can help determine when to schedule a patient for transplantation.
CKD may contribute to the development of heart disease, so physicians keep a close eye on CKD patients' heart health. However, they are reluctant to perform coronary angiography—which uses dye and x-rays to show the inside of the heart's arteries—in CKD patients, who are thought to have an increased risk of experiencing complications from the procedure. This is unfortunate because coronary angiography can help determine whether a patient is healthy enough to undergo a kidney transplant.
To determine the true risks of the test for patients with advanced CKD, Nicky Kumar, MBChB, MRCP (West London Renal and Transplant Centre, Imperial College Kidney and Transplant Institute, London), and her colleagues analyzed 76 patients with late stage CKD who were potential transplant recipients seen at their clinics from 2004 to 2007. Kidney function measurements were recorded 12 months before and 12 months after patients underwent coronary angiography.
The researchers found that patients' kidney function was similar before and after coronary angiography, indicating that the procedure was not harmful to the kidneys. The screening technique detected coronary artery disease in 23 patients, making them unsuitable for transplantation until their heart complications were addressed. Twenty-two patients' tests indicated that they were healthy enough to receive a transplant instead of going on dialysis. This kind of information is key to optimal patient care, since administering a kidney transplant before the patient needs dialysis is the most effective treatment for CKD.
The authors report no financial disclosures. Study co-authors include Lynn Dahri, RGN, Wendy Brown, RGN, MSc, Neill Duncan, MBBS, MRCP, Seema Singh MSc, Andrew Palmer, FRCP, Megan Griffith, FRCP, PhD, Tom Cairns, MBBS, and David Taube, FRCP (West London Renal and Transplant Centre, Imperial College Kidney and Transplant Institute, London); Christopher Baker, FRCP, PhD, and Iqbal Malik, MBBChir, MA, MRCP (Imperial College Healthcare NHS Trust, London).
The article, entitled "Effect of Elective Coronary Angiography on Glomerular Filtration Rate in Patients with Advanced Chronic Kidney Disease," will appear online at http://cjasn.asnjournals.org/ on October 15, 2009, doi 10.2215/CJN.01480209.
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