During the past 20 years, the recognition that most patient groups with kidney failure experience survival and quality-of-life benefits with transplantation versus dialysis has resulted in increasing medical complexity and comorbid condition burden among the population seeking evaluation for and awaiting kidney transplantation.1,2 Given the markedly increased risk for cardiovascular disease in patients with chronic kidney disease (CKD) and the high prevalence of additional cardiovascular risk factors such as diabetes, screening asymptomatic patients for coronary artery disease (CAD) before transplantation may appear on its face to be a logical step in the evaluation of potential candidates.