CardioExchange Archive

Can Two Million Kidneys Be Wrong? A new meta-analysis in the Lancet offers strong evidence that glomerular filtration rate and albuminuria are powerful independent predictors of all-cause and cardiovascular mortality in the general population. Members of the Chronic Kidney Disease Prognosis Consortium used data from over 100,000 participants in studies utilizing urine albumin-to-creatinine ratio (ACR) measurements and more than 1.1 million participants in studies utilizing urine protein dipstick measurements.

In studies utilizing ACR measurements, all-cause mortality was unrelated to eGFR when it was in the optimal range, but the risk of death increased as eGFR decreased. When eGFR reached 15 mL/min/1.7 m(2), the mortality risk was tripled. Findings were comparable for cardiovascular mortality. In the studies utilizing dipstick measurements, a similar pattern was observed.

The new data “confirm beyond doubt that the current thresholds are indicative of increased all-cause and cardiovascular mortality risk,” write Giovanna Leoncini and colleagues in an accompanying Comment.

What Is the Clinical Utility of CTA? Weustink and colleagues performed a stress test and CT angiography (CTA) on 517 patients, more than half of whom also had invasive coronary angiography (ICA). In their paper in the Annals of Internal Medicine, they found that stress tests were less accurate than either CTA or ICA, while CTA results were very close to ICA results. They concluded that stress testing was sufficient for low-risk patients and that high-risk patients should proceed directly to ICA. For intermediate-risk patients, however, CTA might be useful to help “distinguish which patients require invasive testing.”