Cai 2010.

Clinical features and settings	Clinical features Patients with ESKD and intermediate to high risk of CAD awaiting kidney transplantation. CAD defined as presence of at least 1 of: age > 50 years, DM, previous MI or stroke, or extracardiac atherosclerosis Setting Geisinger Medical Center, Danville, Pennsylvania, USA
Participants	Patients at intermediate to high risk of CAD underwent DSE 1 to 12 months (median 5 months) before kidney transplantation Number: 38 DM: 54% Angina pectoris: percentage not reported Hypertension: 86% Sex: 64% male
Study design	Retrospective cohort study.
Target condition and reference standard(s)	Coronary artery stenosis measured by coronary angiography The criterion for positive test results was ≥ 70% reduction in cross sectional area.
Index and comparator tests	DSE Performed according to a standard dobutamine‐atropine protocol and included complete resting echo‐Doppler cardiography. Incremental doses of dobutamine (5 to 50 mg/kg/min) infused at 3 minute intervals. If the target (85% predicted maximum for age) heart rate was not reached, and in the absence of inducible ischaemia, 0.25 mg IV atropine administered up to a maximum dose of 1 mg. Echocardiographic images were obtained in the standardised parasternal long‐ and short‐axes (midventricular and apical), and in apical 2‐, 3‐, 4‐, and 5‐chamber views at each stage, and were stored digitally. DSE end points were defined as development of new or worsening wall motion abnormality (ischaemia), achievement of > 85% of the predicted maximum heart rate for age, severe symptoms of angina or dyspnoea, SBP < 85 mm Hg or > 220 mm Hg or a decrease in SBP > 20 mm Hg from one stage to the next, > 2 mV ST segment depression in at least 2 consecutive leads, or significant arrhythmias (non‐sustained/sustained ventricular/supraventricular tachycardia or high‐grade atrioventricular block).
Follow‐up	Patients were followed up for a mean of 60 months (range 3 to 145 months) after DSE. The time from kidney transplant to follow‐up was 1 to 135 months (median 49 months).
Notes	For the purpose of the analysis, only inducible wall motion abnormalities were counted as positive DSE.
Table of Methodological Quality
Item	Authors' judgement	Description
Representative spectrum? All tests	Yes	Patients with ESKD and intermediate to high risk of CAD awaiting kidney transplantation.
Acceptable reference standard? All tests	Yes	Coronary angiography with a reference standard threshold of ≥ 70% stenosis.
Acceptable delay between tests? All tests	Unclear	Likely to be short delay between tests.
Partial verification avoided? All tests	No	38 patients (23 with and 15 without inducible ischaemia on DSE) underwent coronary angiography after DSE.
Differential verification avoided? All tests	Yes	Disease status (CAD) diagnosed by coronary angiography.
Incorporation avoided? All tests	Yes	Disease status (CAD) diagnosed by coronary angiography.
Reference standard results blinded? All tests	Unclear	Not reported.
Index test results blinded? All tests	Unclear	Not reported.
Relevant clinical information? All tests	Yes	Relevant clinical information was provided regarding the performance and analysis of both the index and reference tests.
Uninterpretable results reported? All tests	Yes	No results were reported to be uninterpretable.
Withdrawals explained? All tests	Yes	All patients missing from the final analysis were accounted for.