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Coronary angiography safe for patients with chronic kidney disease

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Coronary angiography is a recommended screening test for many patients undergoing kidney transplantation and now new research shows that it can be performed in those with advanced chronic kidney disease (CKD) without further impairing kidney function.

Research has shown that outcomes are improved when kidney transplantation is performed before a patient with advanced CKD requires dialysis. However, before transplantation can take place, coronary angiography with possible revascularization is advised for patients over 50 years, those with diabetes, and all candidates with cardiac symptoms or disease, according to the new report.

Concerns have been raised that, because of the risk of contrast-induced nephropathy, coronary angiography may precipitate the need for dialysis, lead author Dr. Nicola Kumar, from Imperial College, London, and colleagues note. Thus, a test that is needed to facilitate preemptive transplantation may at the same time prevent its use.

To investigate the impact of coronary angiography on kidney function, the researchers analyzed data from 482 patients with stage IV/V CKD who were seen from 2004 to 2007. The study focused on 76 of the patients (15.8%) who were transplant candidates and underwent coronary angiography.

The researchers report their findings in the October 15th online issue of the Clinical Journal of the American Society of Nephrology.

The average Modification of Diet in Renal Disease glomerular filtration rate at coronary angiography was 12.46 mL/min, the report indicates. Importantly, this rate did not change significantly from 6 months prior to angiography to 6 months afterward. Cumulative dialysis-free survival was 89.1% at 6 months after angiography.

Flow-limiting coronary disease was identified in 23 of 76 patients (30.3%), the authors note. Twenty-five patients (32.9%) underwent transplantation and in all but three cases, the operation was performed preemptively.

“Coronary angiographic screening did not accelerate the decline in renal function for patients with advanced CKD, which has enabled the facilitation of a safe and prompt preemptive transplantation program,” the authors conclude.

Clin J Am Soc Nephrol 2009.