Evaluation and treatment of ischemic cardiac risk

Purpose of review The present review assesses publications from 2005 until the present addressing optimal cardiovascular disease risk stratification and treatment prior to kidney transplant surgery and appropriate treatment of cardiovascular risk factors after transplantation. Recent findings Both traditional and nontraditional cardiovascular risk factors place patients with end-stage renal failure at high risk for cardiovascular events and mortality, and care must be taken in assessing perioperative risk prior to surgery. Review of recently published literature on noninvasive screening tests and revascularization strategies suggests that current noninvasive stress tests are suboptimal in the end-stage renal disease population. If significant coronary artery disease is identified, patients with chronic kidney disease may benefit from percutaneous intervention with stent placement, while patients with end-stage renal disease most probably benefit more from coronary artery bypass surgery. Summary An aggressive approach to risk factor modification and identification of cardiovascular disease in potential kidney transplant recipients is warranted to decrease perioperative morbidity and mortality. In addition, there are multiple opportunities for improving cardiovascular outcomes after transplantation. Well designed prospective studies with cardiovascular disease events and mortality as outcomes are essential to determine the optimal therapeutic strategies.