Credit: Original article published here.Patients being evaluated for kidney transplant routinely undergo screening for coronary heart disease (CHD). Testing, both noninvasive and invasive, in asymptomatic patients is prevalent in clinical practice, and 40% of Medicare beneficiaries who underwent kidney transplantation were screened for CHD in the year prior to transplantation. Numerous studies published in the 2000s argued against CHD screening in asymptomatic patients. However, proponents of screening contend that the trials did not include patients with advanced kidney disease and/or did not examine perioperative risk specifically. In addition, regulatory agencies have used posttransplant survival as the primary metric to evaluate and accredit transplant programs, creating an incentive to avoid perioperative events that may be associated with early death. According to Xingxing S. Cheng, MD, MS, and colleagues, there are few data demonstrating the positive association of CHD screening with kidney transplant outcomes. The researchers conducted a retrospective cohort study designed to estimate the association of pretransplant CHD testing with rates of death and myocardial infarction (MI). Results were reported online in JAMA Internal Medicine [doi:10.1001/jamainternmed.2022.6069]. The study included all adult, first-time kidney transplant recipients from January 2000 through December 2014 in the US Renal Data System. Eligible patients had at

Credit: Original article published here.Currently in the United States there are more than 500,000 patients with kidney failure on dialysis. The preferred treatment for kidney failure is kidney transplantation. Compared with dialysis, transplantation is associated with longer survival, better quality of life, and fewer hospitalizations. There are national policy directives for dialysis facilities designed to maximize access to transplantation and incentivize waitlisting. However, according to Rachel E. Patzer, PhD, MPH, and colleagues, only ~18.5% of patients with kidney failure are on the transplant waitlist. Further, there is significant variation in access to the waitlist and subsequent transplant. In December 2014, the United Network for Organ Sharing (UNOS) Organ Procurement and Transplantation Network (OPTN) implemented a policy that has had substantial impact on the way kidneys are allocated. Improvement in transplantation access equity was a major goal of the new kidney allocation system (KAS). The primary determinant of priority for organ allocation is allocation time. The new system changed the start of the allocation time from the date of waitlisting to the date of dialysis initiation (with the exception for pre-emptively waitlisted patients). Since the implementation of KAS, waitlisting has declined. It is unknown whether the decline was due to a