The Argument for Abolishing Cardiac Screening of Asymptomatic Kidney Transplant Candidates

Cardiovascular disease is the leading cause of death for individuals with end-stage renal disease. Due to concern about cardiac fitness, international guidelines support screening algorithms based on clinical risk factors for people with kidney failure who wish to consider kidney transplantation surgery. The stated aim of cardiac screening is to identify asymptomatic kidney transplantation candidates with potentially significant pathology that either allows risk stratification or facilitates intervention. This will enable some to proceed toward kidney transplant listing while others will be denied kidney transplantation due to perceived risks. The ultimate aim is to attenuate the risk for peri- or early postoperative cardiovascular mortality after kidney transplantation while maximizing the utility of scarce donor organs. However, heterogeneous recommendations for cardiac screening from international professional and/or society guidelines reflect the lack of evidence base to support published advice. Currently established screening strategies lack evidence for efficacy, incur substantial expense, and can be associated with significant risk for harm. In this Perspective article, the argument is made that current cardiac screening algorithms for asymptomatic kidney transplantation candidates are overzealous, counterproductive, and not in the best interests of the majority of people living with kidney failure and should be abolished.