Following the progress in kidney transplantation and post-transplantation care the mortality rate among kidney transplant recipients was significantly reduced in the 60’s and 80’s of last century. It was the result of reduced number of deaths caused by infectious complications (1). On the other hand, the increase of cardiovascular (CV) mortality (1) resulted that the number of deaths remained constant in subsequent years. Currently, death among patients with functioning graft is the leading cause of graft loss and CV diseases are the major cause of death in that population (2, 3). It refers to approximately 50-60% of deaths, including 47% of deaths in the first 30 days after the transplantation by the incidence of coronary artery disease estimated on 1 per 100 patient-years of risk (2-5).

It should be noticed, that successfully completed kidney transplantation improves renal function and causes patient transfer from stage 5 in the KDIGO classification (eGFR < 15 ml/min) to stage 3, rarely to stage 1 or 2. It has been proven, that the risk of cardiovascular diseases increases with the stage of chronic kidney disease and is the highest in the population of dialysis patients (6). Cardiovascular diseases cause from 40 to over 60% of all deaths in this population (7, 8) as also in the population of kidney transplant recipients. The risk of death from cardiovascular diseases is higher among younger patients if compared to general population. Mortality among hemodialysis patients aged 25-44 years is comparable to those over 75 years old with normal renal function (8). It is associated with the occurrence of classic risk factors in the general population (Framingham Heart Study) such as: older age, male gender, hypertension, diabetes mellitus, hypercholesterolemia, smoking, no physical activity, charged family history of cardiovascular diseases (9, 10). There are also additional, specific for chronic kidney disease risk factors, predisposing to the development of cardiovascular diseases. They include: deterioration of renal function, resulting the recurrence of the primary disease, genetic predisposition to progression of chronic renal disease or abnormalities occurring secondary to renal disease, such as hypoalbuminemia, fluid overload, anemia, malnutrition, lipid disorders, chronic inflammation, calcium – phosphate hemostasis disorders (11-14).

They become very important by beginning chronic graft dysfunction, which causes progression of chronic kidney disease, leading to end-stage renal disease and dialysis. Moreover, the majority of kidney transplant recipients was dialyzed for many months or years before transplantation, that was associated with accelerated atherosclerosis progress in those population (15). Cardiovascular diseases diagnosed before transplantation were the strongest predictor of cardiovascular complications after transplantation (15, 16). On the other hand, the presence of blood vessels calcifications before transplantation correlated with higher mortality after transplantation – although no direct relationship was observed (17, 18).

Therefore classic, as also non-classic risk factors of cardiovascular diseases influence directly or indirectly the progression of chronic kidney disease (19). Among kidney transplant recipients there are also factors related to the transplantation, such as: graft loss, obesity, acute kidney rejection, delayed function of the graft, proteinuria, viral infections (e.g.: Cytomegalovirus) or side effects of immunosuppressive therapy (e.g. post--transplantational diabetes mellitus, hypertriglyceridemia, hypercholesterolemia).

Coronary artery disease (CAD) in patients with end-stage renal disease (ESRD) occurs more often than in the general population. Mortality in dialysis patients is extremely high; nearly every fourth patient dies during the annual observation. Most deaths occur from cardiovascular causes (20-22). The most important prognostic factor in patients with CAD is the evaluation of myocardial ischemia. However, the determination of the ischemia in dialysis patients is complicated. Non-invasive diagnostic is extremely difficult, because additional tests are characterized by low sensitivity and specificity. The sensitivity of non-invasive tests according to various sources were assessed from 52 to 95% and specificity of 71 to 94% (23, 24).

The symptoms of coronary artery disease in dialysis patients are often atypical. Atypical clinical symptoms, constantly increased levels of myocardial necrosis markers in patients with chronic kidney disease, including dialysis patients as also difficulties in ECG interpretation make the proper diagnosis difficult (24).