HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Kumar, N. Articles by Taube, D. PubMed PubMed Citation Articles by Kumar, N. Articles by Taube, D.

Effect of Elective Coronary Angiography on Glomerular Filtration Rate in Patients with Advanced Chronic Kidney Disease

Nicola Kumar^*, Lynn Dahri^*, Wendy Brown^*, Neill Duncan^*, Seema Singh^*, Christopher Baker, Iqbal Malik, Andrew Palmer^*, Megan Griffith^*, Tom Cairns^*, and David Taube^*

^* Department of Renal and Transplantation Medicine, West London Renal and Transplant Center, Imperial College Kidney and Transplant Institute, London, United Kingdom; and Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom

Correspondence: Dr. Nicky Kumar, West London Renal and Transplant Center, Imperial College Kidney and Transplant Institute, Du Cane Road, London, United Kingdom, W12 OHS. Phone: 07929978231; E-mail: nicky.kumar{at}imperial.nhs.uk or nicky.kumar{at}gmail.com

Background and objectives: Preemptive transplantation is ideal for patients with advanced chronic kidney disease (CKD). The practice has been to perform coronary angiography (CA) on all patients aged >50, all diabetics, and all patients with cardiac symptoms or disease with a view to revascularization before transplantation. Historically patients have delayed CA until established on renal replacement therapy due to concerns of precipitating the need for chronic dialysis. The objectives of this study were to establish the risk of contrast nephropathy in patients with advanced CKD who undergo screening CA, and to determine whether or not preemptive transplantation is achievable.

Design and setting: This retrospective analysis included 482 patients with stage IV/V CKD seen in West London predialysis clinics from 2004 to 2007. Seventy-six of 482 (15.8%) patients considered as potential transplant recipients met the authors’ criteria for coronary angiography. Modification of Diet in Renal Disease (MDRD) GFR measurements were recorded for the 12 mo preceding and 12 mo following CA unless a defined endpoint was reached (transplantation, dialysis, or death).

Results: Mean MDRD GFR at CA was 12.51 ± 3.51 ml/min. The trend was not significantly different 6 mo pre- and postangiography. Cumulative dialysis-free survival was 89.1% 6 mo postangiography. Twenty-three of 76 (30.3%) patients had flow-limiting coronary artery disease. Twenty-five of 76 (32.9%) patients underwent transplantation with 22 of 25 (88.0%) transplants being performed preemptively.

Conclusions: The data suggest CA screening does not accelerate the decline in renal function for patients with advanced CKD, facilitating a safe preemptive transplant program.