Assessment and management of coronary artery disease in kidney and pancreas transplant candidates

Joseph T. Knapper, Zankhana Raval, Matthew E. Harinstein, John J. Friedewald, Anton I. Skaro, Michael I. Abecassis, Ziad A. Ali, Mihai Gheorghiade, James D. Flaherty*

*Corresponding author for this work

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Patients with end-stage renal disease (ESRD) undergoing evaluation for kidney and/or pancreas transplantation represent a population with unique cardiovascular (CV) profiles and unique therapeutic needs. Coronary artery disease (CAD) is common in patients with ESRD, mediated by both the overrepresentation and higher prognostic value of traditional CV risk factors amongst this population, as well as altered cardiovascular responses to failing renal function, likely mediated by dysregulation of the renin–angiotensin–aldosterone system (RAAS) and abnormal calcium and phosphate metabolism. Within the ESRD population, obstructive CAD correlates highly with adverse coronary events, including during the peri-transplant period, and successful revascularization may attenuate some of that increased risk. Accordingly, peri-transplant coronary risk assessment is critical to ensuring optimal outcomes for these patients. The following provides a review of CAD in patients being evaluated for kidney and/or pancreas transplantation, as well as evidence-based recommendations for appropriate peri-transplant evaluation and management.

Original languageEnglish (US)
Pages (from-to)51-58
Number of pages8
JournalJournal of Cardiovascular Medicine
Volume20
Issue number2
DOIs
StatePublished - Feb 2019

Fingerprint

Coronary Artery Disease
Pancreas
Chronic Kidney Failure
Transplants
Kidney
Pancreas Transplantation
Kidney Transplantation
Population
Therapeutics

Keywords

  • Coronary artery disease
  • End-stage renal disease
  • Renal transplant

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Knapper, Joseph T. ; Raval, Zankhana ; Harinstein, Matthew E. ; Friedewald, John J. ; Skaro, Anton I. ; Abecassis, Michael I. ; Ali, Ziad A. ; Gheorghiade, Mihai ; Flaherty, James D. / Assessment and management of coronary artery disease in kidney and pancreas transplant candidates. In: Journal of Cardiovascular Medicine. 2019 ; Vol. 20, No. 2. pp. 51-58.
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Assessment and management of coronary artery disease in kidney and pancreas transplant candidates. / Knapper, Joseph T.; Raval, Zankhana; Harinstein, Matthew E.; Friedewald, John J.; Skaro, Anton I.; Abecassis, Michael I.; Ali, Ziad A.; Gheorghiade, Mihai; Flaherty, James D.

In: Journal of Cardiovascular Medicine, Vol. 20, No. 2, 02.2019, p. 51-58.

Research output: Contribution to journalReview article

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T1 - Assessment and management of coronary artery disease in kidney and pancreas transplant candidates

AU - Knapper, Joseph T.

AU - Raval, Zankhana

AU - Harinstein, Matthew E.

AU - Friedewald, John J.

AU - Skaro, Anton I.

AU - Abecassis, Michael I.

AU - Ali, Ziad A.

AU - Gheorghiade, Mihai

AU - Flaherty, James D.

PY - 2019/2

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AB - Patients with end-stage renal disease (ESRD) undergoing evaluation for kidney and/or pancreas transplantation represent a population with unique cardiovascular (CV) profiles and unique therapeutic needs. Coronary artery disease (CAD) is common in patients with ESRD, mediated by both the overrepresentation and higher prognostic value of traditional CV risk factors amongst this population, as well as altered cardiovascular responses to failing renal function, likely mediated by dysregulation of the renin–angiotensin–aldosterone system (RAAS) and abnormal calcium and phosphate metabolism. Within the ESRD population, obstructive CAD correlates highly with adverse coronary events, including during the peri-transplant period, and successful revascularization may attenuate some of that increased risk. Accordingly, peri-transplant coronary risk assessment is critical to ensuring optimal outcomes for these patients. The following provides a review of CAD in patients being evaluated for kidney and/or pancreas transplantation, as well as evidence-based recommendations for appropriate peri-transplant evaluation and management.

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