*Purpose: Chronic kidney disease (CKD) and diabetes (DM) are both associated with increased risk of coronary artery disease and Major Adverse Cardiovascular Events (MACE). The relationships between CKD, DM , non-invasive PET-CT CFR and MACE remain uncertain. We examined CFR among DM and non-DM CKD patients and associations with MACE in patients referred for RTx Evaluation.

*Methods: Single center, retrospective cohort analysis of patients with chronic CKD referred for cardiac PET-CT as part of pre-RTx ischemic risk assessment. CFR was calculated as the ratio of peak myocardial blood flow (MBF) with pharmacologic vasodilation compared with resting blood flow. MBF was assessed with Siemens PET-CT/ Syngo.Via.. Study cohort was compared to an age/gender matched controls without CKD. MACE were assessed at 60 days, 1 and 2 yrs post PET-CT;MACE defined as all-cause death or coronary revascularization.

*Results: As expected CKD RTx candidates had a higher proportion of DM vs.the control group. Verse the control group, CFR was lower among CKD with and without DM. Furthermore, CFR was significantly lower among CKD patients with and without DM who suffered MACE ; p-value for MACE events: 1) CKD patients with versus without DM =0.07 at 60 days; 0.006 at 1 year, 0.009 at 2 years; 2) Control patient with versus without DM =<<0.001 at 60 days; <<0.001 at 1 year, <<0.001 at 2 years

*Conclusions: CKD associates with decreased coronary flow reserve in patients with and without diabetes. Among patients referred for renal transplant evaluation , reduced global coronary flow reserve is associated with increased risk of near and long-term MACE events. Results support utility of PET-CT CFR in candidate evaluation and waitlist management.

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