Ferreira 2007.

Clinical features and settings	Clinical features Kidney transplant candidates with diabetic kidney disease or other causes of CKD or ESKD undergoing cardiac evaluation. Examinations performed one day after haemodialysis. Setting Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital do Rim e Hipertensão e Hospital São Paulo, Brazil
Participants	Aged > 40 years, who presented with ≥ 2 risk factors Number: 126 participants DM: 27% Angina pectoris: 12% Hypertension: not reported Sex: 69% male Exclusion criteria Previous history of MI or surgical or percutaneous myocardial revascularization; unstable angina; decompensated CHF; significant aortic stenosis; pulmonary HTN; hypertrophic cardiomyopathy; inadequate echocardiographic window; atropine use restrictions (glaucoma and obstructive uropathy); irregular dialysis regimen.
Study design	Cross sectional 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	Dobutamine/atropine stress echocardiography Progressive doses of dobutamine 5, 10, 20, 30 and 40 μg/kg/min, with an increment every 3 minutes. In cases when the final objective of the evaluation had not been reached, 0.25 mg/min atropine was added simultaneously after the third minute of the infusion of 40 μg/kg/min of dobutamine, up to a total maximum cumulative dose of 1 mg. The test was considered diagnostic when either 85% of the maximum for age or echocardiographic signs of myocardial ischaemia was reached. The test was considered non‐diagnostic when there were inadequate images for the analysis (lack of definition on ≥ 2 myocardial segments); inability to reach target stress, and premature test withdrawal due to limiting side effects without attaining one of the test aims.  Definitions guiding interpretation were: Normal result defined as uniform increase of systolic movement and thickening of the left ventricular wall and consequent reduction of its final systolic volume (global hyperdynamic response); a positive result for myocardial ischaemia was defined as a new alteration of the reversible segmental contractility or worsening of a pre‐existing segmental alteration, in ≥ 2 contiguous myocardial segments.
Follow‐up
Notes
Table of Methodological Quality
Item	Authors' judgement	Description
Representative spectrum? All tests	Yes	Patients with ESKD who were kidney transplant candidates undergoing cardiac evaluation. Examinations performed one day after haemodialysis.
Acceptable reference standard? All tests	Yes	Coronary angiography with a reference standard threshold of ≥ 70% stenosis.
Acceptable delay between tests? All tests	Yes	Not longer than 2 months.
Partial verification avoided? All tests	Yes	All participants who underwent an index test also received the reference standard test.
Differential verification avoided? All tests	Yes	This was not an issue in this study. Disease status (CAD) is diagnosed only through coronary angiography.
Incorporation avoided? All tests	Yes	This was not an issue in this study. Disease status (CAD) is diagnosed only through coronary angiography.
Reference standard results blinded? All tests	Yes	The measurement bias was controlled through the “blind” interpretation of the test regarding the coronary angiography, which was considered the reference standard.
Index test results blinded? All tests	Yes	The recorded images were later interpreted by two members who were blinded to the patients’ clinical data, as independent observers. The discordance was solved by consensus between the two observers.
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	Of 148 patients submitted to the test, 135 finished the protocol, which corresponds to a feasibility of 91%. The reasons that led to test interruption were: attaining 85% of maximum CF for age: 121 (81%); limiting side effects: 13 (9%); echocardiographic signs of ischaemia: 10 (7%) and end of the protocol: 4 (3%).
Withdrawals explained? All tests	Yes	Thirteen patients presented an early withdrawal of the protocol due to limiting side effects: 12 (8.5%) due to hypertensive response and 1 (0.5%) due to severe angina.