Benefits of early transplantation in patients with chronic renal failure undergoing coronary revascularization

Abstract

Objective: This study aimed to evaluate the effectiveness of post-revascularization surgery in reducing future cardiac events among kidney transplant candidates. Additionally, the role of non-invasive diagnostic techniques and the use of coronary angiography in determining the prognosis of patients scheduled for kidney transplantation were examined.

Material and Methods: A retrospective analysis was conducted on 202 renal transplant recipients who underwent their first coronary revascularization procedure after initiating renal replacement therapy between January 2021 and December 2021. Demographic data collected included patient age, sex, race, duration of prior end-stage renal disease, and primary renal diagnosis.

Results: The study population consisted of 120 men and 82 women, with a mean age of 56.9 years. Diabetes mellitus (DM) and hypertension (HT) were present in 58.4% and 89.6% of the patients, respectively. Coronary angiography was performed in 30% of patients considered at risk. The median graft rejection time was 145 days according to Kaplan-Meier analysis.

Discussion: Coronary artery disease (CAD) has a significant negative impact on the pre-, intra-, and post-transplant survival of patients with chronic kidney disease. Myocardial revascularization is recommended in selected patients with unstable cardiac symptoms or chronic kidney disease, providing long-term survival benefits. Collaborative decision-making between cardiologists and nephrologists is crucial to provide optimal care for this high-risk patient population. Lifestyle modifications, risk factor control, and careful patient selection for myocardial revascularization are key in managing coronary artery disease in chronic kidney disease patients.

Conclusion: Managing coronary artery disease in chronic kidney disease patients, especially those who are candidates for kidney transplantation, requires a comprehensive approach. Optimal treatment strategies should consider the intricate relationship between cardiovascular and renal factors. Collaborative care involving cardiologists, nephrologists, and transplant specialists, as well as a focus on both myocardial revascularization and medical therapy, can lead to improved outcomes. Further research is needed to refine treatment guidelines and strategies for this high-risk patient population.