P8.089: Heart-Kidney Team: Cardiovascular Profile and Outcomes in Kidney Transplant Candidatesed

Abstract

Introduction: Renal transplant is one of the most important treatments in the end stage of chronic kidney disease (CKD). This treatment improves quality of life and reduces mortality compared to patients who remain on dialysis. However, it is known that kidney transplant candidates have multiple comorbidities, which must be carefully evaluated, because they have an important influence on the perioperative risk and post-transplant survival. In addition, cardiovascular disease is the mean cause of death in patients with CKD and in kidney recipients. Therefore, an adequate heart-kidney team evaluation prior to transplantation is essential, not only to prevent perioperative complications, but also to improve short- and long-term results in the post-transplant stage. The opportunity to detect the presence of coronary disease in asymptomatic patients makes possible the implementation of therapeutic strategies prior to kidney transplant and provides useful information to reduce perioperative cardiovascular risk and mortality in these patients. Despite this, the presence of cardiovascular disease could determine the transplant contraindication in certain situations. Up to the present, there are no single consensus on cardiac evaluation in kidney transplant candidates, and the methods chosen for screening for cardiovascular disease are still empirical. The objectives of the study are to determine: (1) history of major adverse cardiac events at the time of the kidney transplant evaluation, (2) proportion of patients in whom stress tests and/or coronary angiography were requested (3) patients underwent coronary revascularization (4) incidence of major cardiac adverse events in kidney transplant recipients and (5) incidence of cardiovascular mortality in the follow-up. Method: A cross-sectional study from January 2010 to December 2019 was performed from a university hospital in Buenos Aires, Argentina. Kidney transplant candidates >18 years with previous hear-kidney team evaluation were included. Results: A total of 153 patients [median age 42.7 years (SD 14.4), 60.8% men] were included in the study. Globally, the prevalence of type 2 diabetes mellitus in the population was 5.2% and 67.5% of patients were hypertensive. Importantly, 22.2% and 89.5% showed a history of cardiovascular disease and prior renal replacement therapy, respectively. In addition, 18.3% and 2.6% of the population required a stress test and coronary angiography, respectively. Baseline characteristics are shown in Table 1. Finally, 1.96% presented cardiovascular events and one patient had cardiovascular death during one year of follow-up. Conclusion: Despite an exhaustive evaluation in kidney transplant candidates, cardiovascular events after renal transplant at one year continue to be significant. This highlights the complexity of the population evaluated and the need to continue improving the heart-kidney team.