Related Articles Cardiac evaluation before kidney transplantation: a practice patterns analysis in Medicare-insured dialysis patients. Clin J Am Soc Nephrol. 2008 Jul;3(4):1115-24 Authors: Lentine KL, Schnitzler MA, Brennan DC, Snyder JJ, Hauptman PJ, Abbott KC, Axelrod D, Salvalaggio PR, Kasiske B BACKGROUND AND OBJECTIVES: Evaluation for ischemic heart disease (IHD) is a nonstandardized practice before kidney transplantation. We retrospectively studied pretransplant cardiac evaluation (CE) practices in a national sample of renal allograft recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The USRDS data for Medicare beneficiaries transplanted in 1991 to 2004 with Part A&B benefits from dialysis initiation through transplantation were examined. Clinical traits defining "high" expected IHD risk were defined as diabetes, prior IHD, or > or = 2 other coronary risk factors. Pretransplant CE were identified by billing claims for noninvasive stress tests and angiography. Patients were quantified with claims for coronary revascularization procedures between CE and transplant. Post-transplant acute myocardial infarction (AMI) events were abstracted from claims and death records. RESULTS: Among 27,786 eligible patients, 46.3% underwent CE before transplantation. Overall, 9.5% who received CE also received pretransplant revascularization, but only 0.3% of lower-risk patients undergoing CE had revascularization. The adjusted odds of tran ...
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