Role of Pretransplant Arteriography in Diabetic End-Stage Renal Disease

Diabetic renal transplant candidates have a high prevalence of obstructive coronary artery disease that is a major cause of morbidity and mortality. This study sought to stratify the risk for renal transplantation by correlating noninvasive tests with arteriographic findings. Fifty-two diabetics (46 males, 6 females) with end-stage renal disease were evaluated noninvasively and by coronary arteriography. The mean age was 46 ± 6 years. Twenty-five patients (48%) had noninvasive evidence of coronary artery disease (angina in 10, old myocardial infarction on electrocardiogram in 6, ST-T changes in 8, regional wall motion abnormality on echocardiography in 8, positive dobutamine echocardiogram in 4, and positive dipyridamole thallium tests in 13). Obstructive coronary artery disease was demonstrated by arteriography in 27 (51.9%). Concordance between noninvasive findings and arteriography was 65.3%. Obstructive coronary disease was present in 66.7% of those with 2 noninvasive indications, in all with more than 2 indications, and in all cases of regional wall motion abnormality. Thus, more than 2 positive noninvasive parameters or wall motion abnormality on an echocardiogram were highly predictive of coronary disease.