Routine Coronary Angiography in Diabetic Nephropathy Patients Before Transplantation

We evaluated the incidence of significant coronary artery stenoses (CAS), angina pectoris (AP), revascularization and associated risk factors in 155 consecutive diabetic nephropathy transplant candidates. Kidney and kidney-pancreas transplant candidates with diabetes for more than 10 years and/or retinopathy and/or biopsy verified diabetic nephropathy were included. The inclusion period was 1999-2004. Seventy-two percent of patients were male. Sixty-one percent had type 1 diabetes and 39% had type 2 diabetes and mean age was 46 years (+/-10) and 58 years (+/-11), respectively. History of heart disease was present in 34% of patients, 34% had cerebro-vascular and/or peripheral atherosclerotic disease, and 51% had neither. Fifty-five percent had a smoking history and 46% were on dialysis. Significant CAS was found in 45% of patients, of whom 17% had AP. No patients below 35 years of age had significant CAS (n = 11, p = 0.001). Revascularization was performed in 57% of patients with significant CAS. The only risk factor for significant CAS in multiple logistic regression was age (p = 0.046). Approximately half of the patients had significant CAS, and half of these underwent revascularization. Most patients with CAS did not have symptoms of myocardial ischemia. The data justify screening diabetic nephropathy transplant candidates with coronary angiography before transplantation.