7-020 Ethnic disparities in echocardiographic and angiographic abnormalities among high-risk renal transplant candidates: a retrospective analysis from a Cardio-Renal MDT

Background Cardiovascular disease (CVD) exhibits marked ethnic disparities,¹ and its importance in the in the context of end-stage kidney disease (ESKD) is increasingly recognised.² In 2022, the Cardio-Renal MDT (CR-MDT) was established at Manchester University NHS Foundation Trust to systematically assess cardiovascular risk in transplant candidates. It was hypothesised that patients from non-Caucasian ethnicity experienced worse outcomes compared to their Caucasian counterparts and that baseline differences in the prevalence and severity of CVD might influence this discrepancy. Aim To compare rates of MPS, echocardiographic and angiographic abnormalities across different ethnic groups amongst high risk ESKD patients referred for transplant assessment. Methods Retrospective analysis of 190 CR-MDT patients (May 2022–November 2024). Patients were grouped by ethnicity (Asian, Afro-Caribbean, Mixed, Caucasian). Demographic and renal data (age, sex, cause of ESKD, baseline eGFR, dialysis status) were extracted from clinical records as well as data from MPS studies, echocardiography and invasive angiography, where performed. Results Table 1 summarises the demographic characteristics of the cohort. South-Asian patients exhibited higher prevalence of diabetes-related ESKD (73.2%) as well as higher rates of pre-existing ischaemic heart disease (46.4%). Table 2 summarises rates of CV abnormalities. MPS data demonstrated similar rates of global ischaemia amongst Caucasian (33.8%) and Asian (27.5%) patients but higher rates of regional ischaemia in Asian patients (58.8% vs 48.1%). Invasive Angiography showed moderate or severe coronary artery disease (CAD) in 74% of non-Caucasian participants and 39% of Caucasian participants. Asian participants had more arteries affected by moderate or severe CAD (figure 1). Analysis of echocardiography revealed higher rates of LVSD in Afro-Caribbean patients (50.0%) and higher rates of diastolic dysfunction in Asian patients (45.1%) in comparison to Caucasian patients (figure 2). Conclusion Patients of Asian and Afro-Caribbean descent demonstrated elevated baseline rates and severity of cardiovascular disease as indicated by MPS, echocardiography and angiography. These findings are consistent with our observations of poorer outcomes in these patient groups. Locally, we are carrying out prospective observational follow up to determine the impact of these baseline disparities on outcomes including peri-operative CV complications. In the interim, targeted cardiovascular screening and interventional strategies for high-risk ethnic groups could improve transplant outcomes. Reference Chaturvedi N. Heart. 2003;89(6):681–686. Adedinsewo DA, et al. Curr Cardiovasc Risk Rep. 2022;16:145–157.