Pre-transplant cardiac evaluation and management of diabetic kidney disease patients before transplant

Evaluation, diagnosis, and management of coronary artery disease (CAD) in patients with chronic kidney disease (CKD) is often challenging considering higher prevalence of CAD in patients with CKD when compared to general population. The morbidity and mortality related to CAD is higher in patients with CKD. More than half of the total mortality in patients with CKD is related to CAD. The presence of diabetes mellitus accelerates atherosclerosis, increasing the risk of cardiovascular events by several folds. Patients with CKD frequently have higher prevalence of conventional cardiovascular risk factors like diabetes mellitus, hypertension, smoking, dyslipidemia, etc. Since CKD patients undergoing renal transplantation with associated CAD have substantially increased chances of allograft failure and higher perioperative risk, these patients need careful evaluation of cardiovascular risk factors and risk stratification prior to procedure. Majority of evidence-based practice guidelines and recommendations rely on prospective clinical trials. However, in majority of clinical trials, patients with CKD have been excluded. Hence, the treating physician often face dilemma in deciding the optimal investigation and treatment strategy for these patients.This article presents the in-depth review of the current clinical evidence-based approach and recommendations on evaluation, diagnosis, and management strategies for patients with diabetic kidney disease who are under consideration for renal transplantation.