NONINVASIVE CARDIAC TESTING IN THE END-STAGE RENAL-DISEASE PATIENT

Renal transplant candidates are at increased risk for future cardiac d eath - approximately 5-10% per year. Invasive testing by coronary angi ography has been used to assess the cardiac risk. However this is expe nsive and carries its own risks to residual renal function as well as cardiac morbidity and mortality. Screening of patients by clinical ris k factors may obviate the need for invasive or noninvasive testing in a significant number (approximately 50%) of the renal transplant candi dates. Further noninvasive testing with exercise or dipyridamole thall ium-201 stress testing in the high-risk patients may be a more cost-ef fective screening test than coronary angiography. Other noninvasive te sting modalities may also prove useful in the future but have not yet been proven in this unique patient population. The characterization of a renal transplant candidate's cardiac risk may assist the clinicians in prioritizing the candidate for transplantation. Recent evidence al so suggests that revascularization of the diabetic renal transplant ca ndidate with significant coronary artery disease (which is approachabl e by angioplasty or bypass surgery) may modify their cardiac risk. Ran domized studies of the efficacy of revascularization or medical therap y interventions in the nondiabetic renal transplant candidate with cor onary artery disease have not been performed.