Screening for occult coronary artery disease in potential kidney transplant recipients: time for reappraisal?

Abstract

Screening for occult coronary artery disease in potential kidney transplant recipients has become entrenched in current medical practice as the standard of care and is supported by national and international clinical guidelines. However, there is increasing and robust evidence that such an approach is out-dated, scientifically, and conceptually flawed, ineffective, potentially directly harmful, discriminates against ethnic minorities and patients from more deprived socio-economic backgrounds and unfairly denies many patients access to potentially lifesaving and life-enhancing transplantation. In this article, we review the available evidence in the light of recently published randomised controlled trials and major observational studies. We propose ways of moving the field forward to the overall benefit of patients with advanced kidney disease.

The Minimisation of Cardiovascular Disease Screening for Kidney Transplant Candidates

“…There is hope CARSK could be a future template for a large RCT in the field, but it has also demonstrated the significant challenges of any future RCT designed to assess minimised cardiac screening-(1) In the preliminary work related to CARSK, 13/15 surveyed Canadian transplant centres were unwilling to randomise to minimised preliminary cardiac screening in asymptomatic individuals (physician bias). ( 2) The trial appears to have required expansion beyond the planned initial 26 centres to 39 centres across seven countries and has currently only recruited 1743 of the required 3200 candidates (demonstrating the reality of recruiting such large numbers in a kidney transplant trial) [35].…”