The effect of coronary angiography on renal function in preemptive renal transplant candidates

Background: Increasing numbers of patients undergo preemptive renal transplantation. Obtaining cardiac catheterizations prior to transplantation to screen for coronary artery disease is controversial because of the perceived risk of inducing contrast nephropathy and the need for dialysis in patients with marginal renal function. We sought to examine the true impact of cardiac catheterization on time to dialysis in a cohort of preemptive renal transplant candidates. Methods: From a cohort of 376 transplant candidates evaluated preemptively at our program between 2/2001 and 4/2005, 34 patients had positive dobutamine stress echocardiograms. We reviewed the subsequent need for dialysis in these patients. Results: Among candidates undergoing angiography, 8.7% required dialysis within 14 d of contrast administration and 26% eventually needed dialysis prior to transplantation at 5.3 +/- 3.7 months after their pre-transplant evaluation. Among patients who did not undergo angiography, 27% needed dialysis prior to transplantation at 2.4 +/- 1.8 months after pre-transplant evaluation. Conclusions: Our results demonstrate a low risk of hastening the need for dialysis after coronary angiography in preemptive renal transplant candidates. Undergoing angiography had no effect on the ultimate need for or timing of dialysis initiation. These findings support completion of full cardiac evaluation as indicated for high-risk preemptive renal transplant candidates.