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 the presence and location of significant aortic atheroma in cardiac surgical patients who require IABP counterpulsation may be useful for risk stratification and optimal IABP positioning under echocardiographic guidance. In these circumstances, alternative placement of an IABP (such as transbrachial) may reduce the likelihood of embolization of aortic atheroma and subsequent perioperative renal dysfunction.5
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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