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To the Editor: The study by Dr Wijeysundera and colleagues¹ established and validated a simplified predictive index for renal replacement therapy after cardiac surgery. We agree with the authors that an association between the degree of vascular calcification, measured as peripheral vascular disease, and the possibility of renal complications in this patient population exists; this association has been previously identified.² In addition, an association between peripheral vascular disease and calcification of the aorta has been shown.³

Wijeysundera et al demonstrated that the preoperative placement of an intra-aortic balloon pump (IABP) increased the likelihood of postoperative renal replacement therapy, also previously noted.⁴ However, we were surprised that the authors did not evaluate a possible synergistic effect of aortic calcification (peripheral vascular disease) and the presence of an IABP. The combination of aortic calcification and IABP counterpulsation might increase the risk of renal dysfunction associated with emboli from aortic atheroma. Knowledge of . . . [Full Text of this Article]

Peter Rosenberger, MD
peter.rosenberger@medizin.uni-tuebingen.de
Department of Anesthesiology and Intensive Care Medicine
Tübingen University Hospital
Tübingen, Germany

Martina Nowak, MD; Stanton K. Shernan, MD
Department of Anesthesiology, Perioperative and Pain Medicine
Brigham and Women's Hospital
Boston, Massachusetts

RELATED LETTER

Predictive Index for Renal Replacement Therapy—Reply
Duminda N. Wijeysundera, Keyvan Karkouti, and W. Scott Beattie
JAMA. 2007;298(7):737-738.
EXTRACT | FULL TEXT  

RELATED ARTICLE

Derivation and Validation of a Simplified Predictive Index for Renal Replacement Therapy After Cardiac Surgery
Duminda N. Wijeysundera, Keyvan Karkouti, Jean-Yves Dupuis, Vivek Rao, Christopher T. Chan, John T. Granton, and W. Scott Beattie
JAMA. 2007;297(16):1801-1809.
ABSTRACT | FULL TEXT