Importance of Comprehensive Cardiovascular Screening in Patients Scheduled for Kidney Donation

INTRODUCTION: End stage renal disease is on the rise in many parts of the world. Kidney transplant is a common procedure and definitive treatment for end stage renal disease. Along with its various advantages, it presents with an array of complications, associated with the procedure. Hence, an effective screening program to identify eligible donors is of crucial importance. The main aim of this study was to identify the frequency of possible undetected cardiovascular abnormalities in scheduled donors and its association with gender.

METHODS: A sample size of 402 was selected with an equal number of donor and non-donor participants after age and gender matching. A positive electrocardiogram (ECG) change was defined as cardiac ischemia, occurring during exercise tolerance test (ETT), with 2 mm horizontal or down sloping ST-segment depression occurring 0.08 milliseconds after J-point whereas an exaggerated blood pressure (BP) was defined as high systolic blood pressure (SBP) at rest to maximum effort ≥7.5mmHg/MET (metabolic equivalents) and/or SBP at the peak of effort ≥220mmHg or subjects with high diastolic blood pressure (DBP) at rest to maximum effort ≥15mmHg, from normal levels of blood pressure at rest. Chi square was used as the primary statistical test.

RESULTS: Scheduled kidney donors had significantly (P=0.007) higher proportion (n=19, 9.5%) of positive ECG changes and exaggerated BP response (n=35, 17.4%) (P<0.0001) compared with the controls. Also, female donors had significantly (P=0.025) higher (n=16, 13.2%) chances of having a positive ECG change.

CONCLUSION: A significant number of kidney donors have undetected cardiovascular abnormalities which could lead to post-transplant complications. Therefore, effective screening should be made imperative to avoid preventable complications such as hypertension of kidney transplantation.