Screening asymptomatic diabetic patients for coronary artery disease prior to renal transplantation

Venkataraman Ramanathan, Simin Goral, Bekir Tanriover, Irene D. Feurer, Rumeyza Kazancioglu, David Shaffer, J. Harold Helderman

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background. Coronary artery disease (CAD) is a significant contributor to excess mortality in renal transplant candidates with diabetes mellitus (DM). Prior studies relating to risk stratification for significant CAD in diabetics are confined to Caucasian type 1 DM patients. Methods. To assess the prevalence of clinically silent CAD and to identify variables that are associated with CAD, we retrospectively analyzed the cardiac catheterization data of 97 asymptomatic type 1 and 2 DM kidney and kidney-pancreas transplant candidates. Results. Thirty-three percent of type 1 and 48% of type 2 DM patients had significant stenosis (≥70%) in 1 or more coronary arteries. On multivariate logistic regression analysis, body mass index (BMI) >25 was significantly associated with CAD (relative risk = 4.8, P = 0.002). The age of the patient (7% increase in risk/year, P = 0.01; or relative risk = 3.0 if age >47 years, P = 0.032) and smoking history (2% increase in risk/pack-year of smoking, P = 0.10) were also associated with CAD. African American patients, who comprised 30% of the sample, had a 71% lower risk compared with Caucasian patients (P = 0.03). Factors that were not significantly associated with CAD included gender, type of diabetes, and whether dialyzed for >6 months prior to catheterization. Conclusions. We conclude that a notable proportion (approximately one-third to one-half) of asymptomatic type 1 and type 2 diabetic renal transplant candidates have significant CAD. Additionally, young African American DM patients with no smoking history and a BMI ≤25 are at reduced risk, and invasive tests may not be necessary in this group.

Original languageEnglish (US)
Pages (from-to)1453-1458
Number of pages6
JournalTransplantation
Volume79
Issue number10
DOIs
StatePublished - May 27 2005

Fingerprint

Kidney Transplantation
Coronary Artery Disease
Kidney
Smoking
Transplants
Type 1 Diabetes Mellitus
African Americans
Type 2 Diabetes Mellitus
Diabetes Mellitus
Body Mass Index
History
Cardiac Catheterization
Catheterization
Pancreas
Coronary Vessels
Pathologic Constriction
Logistic Models
Regression Analysis
Mortality

Keywords

  • Body mass index
  • Cardiac catheterization
  • Coronary artery disease
  • Diabetes
  • Renal failure

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Ramanathan, V., Goral, S., Tanriover, B., Feurer, I. D., Kazancioglu, R., Shaffer, D., & Harold Helderman, J. (2005). Screening asymptomatic diabetic patients for coronary artery disease prior to renal transplantation. Transplantation, 79(10), 1453-1458. https://doi.org/10.1097/01.TP.0000164147.60036.67

Screening asymptomatic diabetic patients for coronary artery disease prior to renal transplantation. / Ramanathan, Venkataraman; Goral, Simin; Tanriover, Bekir; Feurer, Irene D.; Kazancioglu, Rumeyza; Shaffer, David; Harold Helderman, J.

In: Transplantation, Vol. 79, No. 10, 27.05.2005, p. 1453-1458.

Research output: Contribution to journalArticle

Ramanathan, V, Goral, S, Tanriover, B, Feurer, ID, Kazancioglu, R, Shaffer, D & Harold Helderman, J 2005, 'Screening asymptomatic diabetic patients for coronary artery disease prior to renal transplantation', Transplantation, vol. 79, no. 10, pp. 1453-1458. https://doi.org/10.1097/01.TP.0000164147.60036.67
Ramanathan, Venkataraman ; Goral, Simin ; Tanriover, Bekir ; Feurer, Irene D. ; Kazancioglu, Rumeyza ; Shaffer, David ; Harold Helderman, J. / Screening asymptomatic diabetic patients for coronary artery disease prior to renal transplantation. In: Transplantation. 2005 ; Vol. 79, No. 10. pp. 1453-1458.
@article{3ab22dfb807349208c59692bf714d1a8,
title = "Screening asymptomatic diabetic patients for coronary artery disease prior to renal transplantation",
abstract = "Background. Coronary artery disease (CAD) is a significant contributor to excess mortality in renal transplant candidates with diabetes mellitus (DM). Prior studies relating to risk stratification for significant CAD in diabetics are confined to Caucasian type 1 DM patients. Methods. To assess the prevalence of clinically silent CAD and to identify variables that are associated with CAD, we retrospectively analyzed the cardiac catheterization data of 97 asymptomatic type 1 and 2 DM kidney and kidney-pancreas transplant candidates. Results. Thirty-three percent of type 1 and 48{\%} of type 2 DM patients had significant stenosis (≥70{\%}) in 1 or more coronary arteries. On multivariate logistic regression analysis, body mass index (BMI) >25 was significantly associated with CAD (relative risk = 4.8, P = 0.002). The age of the patient (7{\%} increase in risk/year, P = 0.01; or relative risk = 3.0 if age >47 years, P = 0.032) and smoking history (2{\%} increase in risk/pack-year of smoking, P = 0.10) were also associated with CAD. African American patients, who comprised 30{\%} of the sample, had a 71{\%} lower risk compared with Caucasian patients (P = 0.03). Factors that were not significantly associated with CAD included gender, type of diabetes, and whether dialyzed for >6 months prior to catheterization. Conclusions. We conclude that a notable proportion (approximately one-third to one-half) of asymptomatic type 1 and type 2 diabetic renal transplant candidates have significant CAD. Additionally, young African American DM patients with no smoking history and a BMI ≤25 are at reduced risk, and invasive tests may not be necessary in this group.",
keywords = "Body mass index, Cardiac catheterization, Coronary artery disease, Diabetes, Renal failure",
author = "Venkataraman Ramanathan and Simin Goral and Bekir Tanriover and Feurer, {Irene D.} and Rumeyza Kazancioglu and David Shaffer and {Harold Helderman}, J.",
year = "2005",
month = "5",
day = "27",
doi = "10.1097/01.TP.0000164147.60036.67",
language = "English (US)",
volume = "79",
pages = "1453--1458",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Screening asymptomatic diabetic patients for coronary artery disease prior to renal transplantation

AU - Ramanathan, Venkataraman

AU - Goral, Simin

AU - Tanriover, Bekir

AU - Feurer, Irene D.

AU - Kazancioglu, Rumeyza

AU - Shaffer, David

AU - Harold Helderman, J.

PY - 2005/5/27

Y1 - 2005/5/27

N2 - Background. Coronary artery disease (CAD) is a significant contributor to excess mortality in renal transplant candidates with diabetes mellitus (DM). Prior studies relating to risk stratification for significant CAD in diabetics are confined to Caucasian type 1 DM patients. Methods. To assess the prevalence of clinically silent CAD and to identify variables that are associated with CAD, we retrospectively analyzed the cardiac catheterization data of 97 asymptomatic type 1 and 2 DM kidney and kidney-pancreas transplant candidates. Results. Thirty-three percent of type 1 and 48% of type 2 DM patients had significant stenosis (≥70%) in 1 or more coronary arteries. On multivariate logistic regression analysis, body mass index (BMI) >25 was significantly associated with CAD (relative risk = 4.8, P = 0.002). The age of the patient (7% increase in risk/year, P = 0.01; or relative risk = 3.0 if age >47 years, P = 0.032) and smoking history (2% increase in risk/pack-year of smoking, P = 0.10) were also associated with CAD. African American patients, who comprised 30% of the sample, had a 71% lower risk compared with Caucasian patients (P = 0.03). Factors that were not significantly associated with CAD included gender, type of diabetes, and whether dialyzed for >6 months prior to catheterization. Conclusions. We conclude that a notable proportion (approximately one-third to one-half) of asymptomatic type 1 and type 2 diabetic renal transplant candidates have significant CAD. Additionally, young African American DM patients with no smoking history and a BMI ≤25 are at reduced risk, and invasive tests may not be necessary in this group.

AB - Background. Coronary artery disease (CAD) is a significant contributor to excess mortality in renal transplant candidates with diabetes mellitus (DM). Prior studies relating to risk stratification for significant CAD in diabetics are confined to Caucasian type 1 DM patients. Methods. To assess the prevalence of clinically silent CAD and to identify variables that are associated with CAD, we retrospectively analyzed the cardiac catheterization data of 97 asymptomatic type 1 and 2 DM kidney and kidney-pancreas transplant candidates. Results. Thirty-three percent of type 1 and 48% of type 2 DM patients had significant stenosis (≥70%) in 1 or more coronary arteries. On multivariate logistic regression analysis, body mass index (BMI) >25 was significantly associated with CAD (relative risk = 4.8, P = 0.002). The age of the patient (7% increase in risk/year, P = 0.01; or relative risk = 3.0 if age >47 years, P = 0.032) and smoking history (2% increase in risk/pack-year of smoking, P = 0.10) were also associated with CAD. African American patients, who comprised 30% of the sample, had a 71% lower risk compared with Caucasian patients (P = 0.03). Factors that were not significantly associated with CAD included gender, type of diabetes, and whether dialyzed for >6 months prior to catheterization. Conclusions. We conclude that a notable proportion (approximately one-third to one-half) of asymptomatic type 1 and type 2 diabetic renal transplant candidates have significant CAD. Additionally, young African American DM patients with no smoking history and a BMI ≤25 are at reduced risk, and invasive tests may not be necessary in this group.

KW - Body mass index

KW - Cardiac catheterization

KW - Coronary artery disease

KW - Diabetes

KW - Renal failure

UR - http://www.scopus.com/inward/record.url?scp=19544392485&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=19544392485&partnerID=8YFLogxK

U2 - 10.1097/01.TP.0000164147.60036.67

DO - 10.1097/01.TP.0000164147.60036.67

M3 - Article

C2 - 15912119

AN - SCOPUS:19544392485

VL - 79

SP - 1453

EP - 1458

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 10

ER -