To the Editor: In a recent commentary1 on Dr Chiu’s study,2 Dr Haas underlines that for the first time an association between all-cause mortality and coronary artery calcification (CAC) score has been ascertained in chronic kidney disease (CKD) patients. We recognize the clinical relevance of the referred study.2 However, mortality rate has been previously evaluated in a cohort of 388 CKD patients (stages: 2–5; 16% diabetics).3 We agree with Dr Haas that all-cause mortality might have hidden the cases due to cardiovascular events in Dr Chiu’s study. Nevertheless, it has been observed that ‘calcified’ CKD patients presented higher cardiovascular mortality compared with noncalcified controls.3 In addition, cardiovascular mortality rate was similar, both in patients with CAC score >100 and >400 (Agatston Unit),3 underlining the fact that CKD patient is more vulnerable, likely having a lower threshold for cardiovascular risk. Dr Haas addresses very interesting questions on potential ways of influencing and/or reversing progression of CAC in order to improve survival. Despite some limitations, two studies may shed light on this challenging matter. In CKD patients not yet on dialysis, Sevelamer significantly reduced CAC progression after a mean observation period of 24 months.4 Faster CAC progression was independently associated to higher cardiovascular mortality.5 Whether interventions able to reduce or reverse CAC progression may improve survival remains to be an unanswered question so far. Large interventional studies are needed on this critical issue in CKD patients not yet on dialysis.

Coronary artery calcification and cardiovascular mortality in predialysis patients / Russo, Domenico; Morrone, L; Russo, L.. - In: KIDNEY INTERNATIONAL. - ISSN 0085-2538. - 79:2(2011), pp. 258-258. [10.1038/ki.2010.405]

Coronary artery calcification and cardiovascular mortality in predialysis patients.

RUSSO, DOMENICO;
2011

Abstract

To the Editor: In a recent commentary1 on Dr Chiu’s study,2 Dr Haas underlines that for the first time an association between all-cause mortality and coronary artery calcification (CAC) score has been ascertained in chronic kidney disease (CKD) patients. We recognize the clinical relevance of the referred study.2 However, mortality rate has been previously evaluated in a cohort of 388 CKD patients (stages: 2–5; 16% diabetics).3 We agree with Dr Haas that all-cause mortality might have hidden the cases due to cardiovascular events in Dr Chiu’s study. Nevertheless, it has been observed that ‘calcified’ CKD patients presented higher cardiovascular mortality compared with noncalcified controls.3 In addition, cardiovascular mortality rate was similar, both in patients with CAC score >100 and >400 (Agatston Unit),3 underlining the fact that CKD patient is more vulnerable, likely having a lower threshold for cardiovascular risk. Dr Haas addresses very interesting questions on potential ways of influencing and/or reversing progression of CAC in order to improve survival. Despite some limitations, two studies may shed light on this challenging matter. In CKD patients not yet on dialysis, Sevelamer significantly reduced CAC progression after a mean observation period of 24 months.4 Faster CAC progression was independently associated to higher cardiovascular mortality.5 Whether interventions able to reduce or reverse CAC progression may improve survival remains to be an unanswered question so far. Large interventional studies are needed on this critical issue in CKD patients not yet on dialysis.
2011
Coronary artery calcification and cardiovascular mortality in predialysis patients / Russo, Domenico; Morrone, L; Russo, L.. - In: KIDNEY INTERNATIONAL. - ISSN 0085-2538. - 79:2(2011), pp. 258-258. [10.1038/ki.2010.405]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/588467
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