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NDT Advance Access originally published online on October 30, 2007
Nephrology Dialysis Transplantation 2008 23(1):409; doi:10.1093/ndt/gfm593
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org


Coronary artery calcification in chronic kidney disease

Email: maaravi{at}md2.huji.ac.il; maaravi3{at}bezeqint.net

Sir,

We read with great interest the paper by Porter et al. [1], recently published in your journal [1]. It examined the prevalence of coronary artery calcification (CAC) in patients with chronic kidney disease (CKD), with and without diabetes. The method used to classify patients into CKD stages was the simplified MDRD equation. Although this method is widespread, it has been criticized for significantly underestimating glomerular filtration rate (GFR) in healthy subjects [2]. It is possible, therefore, for a misclassification bias to occur in the above study, affecting the reported prevalence of CAC.

The Mayo Clinic equation was developed by Rule et al. [2] to overcome the shortcomings of the current GFR-estimating equations.

We have recently compared the MDRD with the Mayo Clinic equation in a community-living elder population and found the latter to reduce misclassification of CKD and better predict related all-cause mortality [3]: the group of subjects having reduced eGFR (<60 ml/min per 1.73 m2) were half the number identified by the MDRD formula, the average eGFR in the higher eGFR group (>60 ml/min per 1.73 m2) was much higher than the MDRD and the prediction of mortality of those with reduced eGFR was significantly better than that of the MDRD.

We suggest the Mayo Clinic equation to be a better formula for classification of subjects with CKD and propose recalculating the results of the above study [1].

Conflict of interest statement. None declared.

Yoram Maaravi1, Michael Bursztyn2 and Jochanan Stessman1

1Department of Rehabilitation
and Geriatrics
2Department of Medicine
Hadassah-Hebrew University
Medical Center
Mt. Scopus
Jerusalem

References

  1. Porter CJ, Stavroulopoulos A, Roe SD, Pointon K, Cassidy MJ. Detection of coronary and peripheral artery calcification in patients with chronic kidney disease stages 3 and 4, with and without diabetes. Nephrol Dial Transplant (2007) [Epub ahead of print].
  2. Rule AD, Larson TS, Bergstralh EJ, Slezak JM, Jacobsen SJ, Cosio FG. Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med (2004) 141:929–937.[Abstract/Free Full Text]
  3. Maaravi Y, Bursztyn M, Hammerman-Rozenberg R, Stessman J. Glomerular filtration rate estimation and mortality in an elderly population. Q J Med (2007) 100:441–449.[Web of Science]

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This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
23/1/409    most recent
gfm593v1
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Google Scholar
Right arrow Articles by Maaravi, Y.
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Right arrow Articles by Maaravi, Y.
Right arrow Articles by Stessman, J.
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