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Predictive Index for Renal Replacement Therapy—Reply
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In Reply: In response to Dr Rosenberger and colleagues, in our original analyses peripheral vascular disease did not meet pre-specified criteria for retention in the final clinical prediction rule. When peripheral vascular disease was forced into the final model, the interaction term between peripheral vascular disease and preoperative IABP was not statistically significant (P = .79). Nonetheless, this finding does not disprove a deleterious interaction between aortic calcification and IABP. Our data set did not capture the presence or location of aortic atheroma; hence, it was not ideally suited to evaluate this physiologically plausible hypothesis. Studies that use methods such as echocardiography to capture this information should be performed, and thereby better determine if optimal IABP positioning attenuates kidney injury.
The inclusion of preoperative IABP use in our clinical prediction rule does not mean that IABP use causes perioperative kidney injury. Interpretation of an observational study such as ours should . . . [Full Text of this Article]
Duminda N. Wijeysundera, MD
duminda.wijeysundera@uhn.on.ca
Keyvan Karkouti, MD, MSc;
W. Scott Beattie, MD, PhD
Department of Anesthesia
Toronto General Hospital
Toronto, Ontario, Canada
RELATED LETTER
Predictive Index for Renal Replacement Therapy
Peter Rosenberger, Martina Nowak, and Stanton K. Shernan
JAMA. 2007;298(7):737.
EXTRACT
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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.
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