Screening asymptomatic diabetic patients for coronary artery disease prior to renal transplantation

Transplantation. 2005 May 27;79(10):1453-8. doi: 10.1097/01.tp.0000164147.60036.67.

Abstract

Background: Coronary artery disease (CAD) is a significant contributor to excess mortality in renal transplant candidates with diabetes mellitus (DM). Prior studies relating to risk stratification for significant CAD in diabetics are confined to Caucasian type 1 DM patients.

Methods: To assess the prevalence of clinically silent CAD and to identify variables that are associated with CAD, we retrospectively analyzed the cardiac catheterization data of 97 asymptomatic type 1 and 2 DM kidney and kidney-pancreas transplant candidates.

Results: Thirty-three percent of type 1 and 48% of type 2 DM patients had significant stenosis (> or = 70%) in 1 or more coronary arteries. On multivariate logistic regression analysis, body mass index (BMI) >25 was significantly associated with CAD (relative risk = 4.8, P = 0.002). The age of the patient (7% increase in risk/year, P = 0.01; or relative risk = 3.0 if age >47 years, P = 0.032) and smoking history (2% increase in risk/pack-year of smoking, P = 0.10) were also associated with CAD. African American patients, who comprised 30% of the sample, had a 71% lower risk compared with Caucasian patients (P = 0.03). Factors that were not significantly associated with CAD included gender, type of diabetes, and whether dialyzed for >6 months prior to catheterization.

Conclusions: We conclude that a notable proportion (approximately one-third to one-half) of asymptomatic type 1 and type 2 diabetic renal transplant candidates have significant CAD. Additionally, young African American DM patients with no smoking history and a BMI </=25 are at reduced risk, and invasive tests may not be necessary in this group.

MeSH terms

  • Adult
  • African Americans / statistics & numerical data
  • Body Mass Index
  • Cardiac Catheterization
  • Coronary Artery Disease / diagnosis*
  • Coronary Artery Disease / epidemiology
  • Coronary Artery Disease / physiopathology
  • Diabetes Complications / ethnology
  • Diabetes Complications / surgery
  • Diabetes Mellitus, Type 1
  • Diabetes Mellitus, Type 2
  • Diabetic Angiopathies / diagnosis*
  • Diabetic Angiopathies / epidemiology
  • Diabetic Angiopathies / physiopathology
  • Diabetic Nephropathies / ethnology
  • Diabetic Nephropathies / surgery*
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Humans
  • Kidney Transplantation*
  • Male
  • Mass Screening*
  • Middle Aged
  • Pancreas Transplantation
  • Pancreatic Diseases / ethnology
  • Pancreatic Diseases / surgery
  • Preoperative Care*
  • Prevalence
  • Retrospective Studies