Screening for Asymptomatic Coronary Artery Disease in Kidney Transplant Candidates
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- STATUS
- Recruiting
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- End date
- Dec 31, 2023
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- participants needed
- 3306
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- sponsor
- University of British Columbia
Summary
The Canadian Australasian Randomized Trial of Screening Kidney Transplant Candidates for Coronary Artery Disease (CARSK) will test the hypothesis that eliminating the regular use of non-invasive screening tests for CAD AFTER waitlist activation is not inferior to regular (i.e., annual) screening for CAD during wait-listing for the prevention of Major Adverse Cardiac Events. Secondary analyses will assess the impact of screening on the rate of transplantation, and the relative cost-effectiveness of screening.
Description
Cardiovascular disease is the commonest cause of death while on the kidney transplant waiting list and after transplantation. Current standard care involves screening for coronary artery disease prior to waitlist entry, then every 1-2 years, according to perceived risk, until transplanted. The aim of screening is two-fold. Firstly to identify patients with asymptomatic coronary disease to enable either correction, by bypass surgery or angioplasty, or removal of the patient from the list, with the ultimate aim of preventing premature cardiovascular mortality at the time of, or soon after kidney transplantation. Secondly, from a societal perspective, to prevent mis-direction of scarce donor organs into recipients who experience early mortality. This current screening strategy is not evidence based, has substantial known and potential harms, and is very costly. Two major issues of uncertainty require addressing in sequence: (1) whether to periodically screen asymptomatic wait-listed patients for occult coronary artery disease; and (2) whether to revascularise coronary stenoses in asymptomatic patients prior to transplantation. The CARSK study seeks to address the first of these 2 issues.
CARSK aims to
- Test the hypothesis that after screening for wait list entry, no further screening for coronary artery disease (CAD) is non-inferior to the current standard care which is screening all asymptomatic wait-listed patients for CAD at regular intervals.
- Compare the benefits and costs of not screening versus regular CAD screening from a health system perspective.
Details
| Condition | Chronic renal failure, Organ Transplantation, Cardiovascular Disease, Renal transplant, Stage 5 Chronic Kidney Disease, Organ Transplant - Pediatric, Chronic Kidney Disease Stage 5, Dialysis Related Complication, CKD Stage 5, Organ Transplant, Kidney Transplantation, kidney transplant, cardiovascular diseases, cardiovascular disease (cvd), cardiovascular system diseases, cardiovascular disorders, renal transplantation, kidney transplants, end stage renal disease, chronic renal disease, end-stage renal disease, esrd, end-stage renal failure, end stage kidney disease, end stage renal failure |
|---|---|
| Treatment | No screening, Regular Screening |
| Clinical Study Identifier | NCT03674307 |
| Sponsor | University of British Columbia |
| Last Modified on | 24 January 2021 |
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