Correspondence
Rate in patients with ARVD
Rate in US general Medicare population
Gradual loss of kidney function with development of chronic kidney disease*
24·6%
End-stage renal disease incidence (per 1000 patient-years)†
28·8%
1·3%
History of acute kidney injury*
10·3%
0·8%
Hypertension (often resistant)*
2·3%
90·8%
53·4%
Flash pulmonary oedema due to episodes of acute exacerbations of congestive heart failure
Almost 8%;can be ameliorated by renal artery revascularisation
Unknown
Death (per 1000 patient-years)†
166·3%
63·3%
ARVD=atherosclerotic renovascular disease. *Prevalence. †Incidence.
Table: Relevant clinical consequences of ARVD2–4
and the degree of renal artery stenosis predicts survival in individuals with atherosclerotic renovascular disease.3 Therefore, we believe that consideration of high serum cholesterol as a risk factor for development of renal artery atherosclerosis and atherosclerotic renovascular disease is crucial for the precise estimation of mortality and morbidity due to chronic kidney disease, and to accurately document the proportion of deaths attributable to different metabolic risk factors in further revisions from the Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. GR has recieved payment to his institution from Abbvie, Alexion Pharmaceuticals, Bayer Healthcare, and Novertis Pharma. BB and NP declare no competing interests.
*Boris Bikbov, Norberto Perico, Giuseppe Remuzzi, on behalf of the Global Burden of Disease Study Genitourinary Disease Expert Group [email protected] Chair of Nephrology, AI Evdokimov Moscow State University of Medicine and Dentistry, Moscow 127463, Russia (BB); Department of Nephrology Issues of Transplanted Kidney, Academician VI Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russia (BB); Moscow City Nephrology Center, Moscow City Hospital 52, Moscow, Russia (BB); Istituto di Ricerche Farmacologiche Mario Negri (IRCCS), Bergamo, Italy (NP, GR); and Unit of Nephrology, Dialysis and Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy (GR) 1
614
The Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol 2014; published online May 17. http://dx. doi:10.1016/S2213-8587(14)70102-0.
with the progression of chronic kidney disease remains mixed,4,5 and randomised trials6,7 showed no effect of statins on end-stage renal diseases. In summary, the association between high cholesterol and atherosclerotic renovascular disease is hypothesised, rather than confirmed, and there is no convincing or probable evidence on the presence of a causal association or its magnitude. We declare no competing interests.
2
3
4
5
Kalra PA, Guo H, Kausz AT, et al. Atherosclerotic renovascular disease in United States patients aged 67 years or older: risk factors, revascularization, and prognosis. Kidney Int 2005; 68: 293–301. Chrysochou C, Kalra PA. Epidemiology and natural history of atherosclerotic renovascular disease. Prog Cardiovasc Dis 2009; 52: 184–95. Ritchie J, Green D, Chrysochou C, Chalmers N, Foley RN, Kalra PA. High-risk clinical presentations in atherosclerotic renovascular disease: prognosis and response to renal artery revascularization. Am J Kidney Dis 2014; 63: 186–97. Hansen KJ, Edwards MS, Craven TE, et al. Prevalence of renovascular disease in the elderly: a population-based study. J Vasc Surg 2002; 36: 443–51.
Authors’ reply
*Majid Ezzati, Goodarz Danaei, on behalf of the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group [email protected] MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London W2 1PG, UK (ME); and Department of Global Health and Poulation, and Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA 1
2
In our analysis of death attributable to cardiometabolic risk factors, 1 we used disease outcomes with convincing or probable evidence of a causal association, which amounted to evidence of an association from randomised trials or from multiple well-done prospective studies. 2 Furthermore, quantification of the number of deaths attributable to risk factors requires data on the magnitude of the causal association, often a relative risk. Atherosclerotic renovascular disease does not currently meet either of these requirements. The report3 cited as evidence of an association by Bikbov and colleagues states “although intuitively hyperlipidaemia should be associated with increased ARVD [atherosclerotic renovascular disease] prevalence, there are no reports that confirm this relationship in the literature”. Evidence from prospective cohort studies for whether serum lipids are associated
3
4
5.
6
7
The Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol 2014; published online May 17. http://dx.doi:10.1016/ S2213-8587(14)70102-0. Singh GM, Danaei G, Farzadfar F, et al. The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: a pooled analysis. PLoS One 2013; 8: e65174. Chrysochou C, Kalra PA. Epidemiology and natural history of atherosclerotic renovascular disease. Prog Cardiovasc Dis 2009; 52: 184–95. Rahman M, Yang W, Akkina S, et al. Relation of Serum Lipids and Lipoproteins with Progression of CKD: The CRIC Study. Clin J Am Soc Nephrol 2014; 9: 1190–98. Baragetti A, Norata GD, Sarcina C, et al. High density lipoprotein cholesterol levels are an independent predictor of the progression of chronic kidney disease. J Intern Med 2013; 274: 252–62. Margolis KL, Davis BR, Baimbridge C, et al. Long-term follow-up of moderately hypercholesterolemic hypertensive patients following randomization to pravastatin vs usual care: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). J Clin Hypertens 2013; 15: 542–54. Baigent C, Landray MJ, Reith C, et al. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet 2011; 377: 2181–92.
www.thelancet.com/diabetes-endocrinology Vol 2 August 2014
Rate in patients with ARVD
Rate in US general Medicare population
Gradual loss of kidney function with development of chronic kidney disease*
24·6%
End-stage renal disease incidence (per 1000 patient-years)†
28·8%
1·3%
History of acute kidney injury*
10·3%
0·8%
Hypertension (often resistant)*
2·3%
90·8%
53·4%
Flash pulmonary oedema due to episodes of acute exacerbations of congestive heart failure
Almost 8%;can be ameliorated by renal artery revascularisation
Unknown
Death (per 1000 patient-years)†
166·3%
63·3%
ARVD=atherosclerotic renovascular disease. *Prevalence. †Incidence.
Table: Relevant clinical consequences of ARVD2–4
and the degree of renal artery stenosis predicts survival in individuals with atherosclerotic renovascular disease.3 Therefore, we believe that consideration of high serum cholesterol as a risk factor for development of renal artery atherosclerosis and atherosclerotic renovascular disease is crucial for the precise estimation of mortality and morbidity due to chronic kidney disease, and to accurately document the proportion of deaths attributable to different metabolic risk factors in further revisions from the Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. GR has recieved payment to his institution from Abbvie, Alexion Pharmaceuticals, Bayer Healthcare, and Novertis Pharma. BB and NP declare no competing interests.
*Boris Bikbov, Norberto Perico, Giuseppe Remuzzi, on behalf of the Global Burden of Disease Study Genitourinary Disease Expert Group [email protected] Chair of Nephrology, AI Evdokimov Moscow State University of Medicine and Dentistry, Moscow 127463, Russia (BB); Department of Nephrology Issues of Transplanted Kidney, Academician VI Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russia (BB); Moscow City Nephrology Center, Moscow City Hospital 52, Moscow, Russia (BB); Istituto di Ricerche Farmacologiche Mario Negri (IRCCS), Bergamo, Italy (NP, GR); and Unit of Nephrology, Dialysis and Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy (GR) 1
614
The Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol 2014; published online May 17. http://dx. doi:10.1016/S2213-8587(14)70102-0.
with the progression of chronic kidney disease remains mixed,4,5 and randomised trials6,7 showed no effect of statins on end-stage renal diseases. In summary, the association between high cholesterol and atherosclerotic renovascular disease is hypothesised, rather than confirmed, and there is no convincing or probable evidence on the presence of a causal association or its magnitude. We declare no competing interests.
2
3
4
5
Kalra PA, Guo H, Kausz AT, et al. Atherosclerotic renovascular disease in United States patients aged 67 years or older: risk factors, revascularization, and prognosis. Kidney Int 2005; 68: 293–301. Chrysochou C, Kalra PA. Epidemiology and natural history of atherosclerotic renovascular disease. Prog Cardiovasc Dis 2009; 52: 184–95. Ritchie J, Green D, Chrysochou C, Chalmers N, Foley RN, Kalra PA. High-risk clinical presentations in atherosclerotic renovascular disease: prognosis and response to renal artery revascularization. Am J Kidney Dis 2014; 63: 186–97. Hansen KJ, Edwards MS, Craven TE, et al. Prevalence of renovascular disease in the elderly: a population-based study. J Vasc Surg 2002; 36: 443–51.
Authors’ reply
*Majid Ezzati, Goodarz Danaei, on behalf of the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group [email protected] MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London W2 1PG, UK (ME); and Department of Global Health and Poulation, and Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA 1
2
In our analysis of death attributable to cardiometabolic risk factors, 1 we used disease outcomes with convincing or probable evidence of a causal association, which amounted to evidence of an association from randomised trials or from multiple well-done prospective studies. 2 Furthermore, quantification of the number of deaths attributable to risk factors requires data on the magnitude of the causal association, often a relative risk. Atherosclerotic renovascular disease does not currently meet either of these requirements. The report3 cited as evidence of an association by Bikbov and colleagues states “although intuitively hyperlipidaemia should be associated with increased ARVD [atherosclerotic renovascular disease] prevalence, there are no reports that confirm this relationship in the literature”. Evidence from prospective cohort studies for whether serum lipids are associated
3
4
5.
6
7
The Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol 2014; published online May 17. http://dx.doi:10.1016/ S2213-8587(14)70102-0. Singh GM, Danaei G, Farzadfar F, et al. The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: a pooled analysis. PLoS One 2013; 8: e65174. Chrysochou C, Kalra PA. Epidemiology and natural history of atherosclerotic renovascular disease. Prog Cardiovasc Dis 2009; 52: 184–95. Rahman M, Yang W, Akkina S, et al. Relation of Serum Lipids and Lipoproteins with Progression of CKD: The CRIC Study. Clin J Am Soc Nephrol 2014; 9: 1190–98. Baragetti A, Norata GD, Sarcina C, et al. High density lipoprotein cholesterol levels are an independent predictor of the progression of chronic kidney disease. J Intern Med 2013; 274: 252–62. Margolis KL, Davis BR, Baimbridge C, et al. Long-term follow-up of moderately hypercholesterolemic hypertensive patients following randomization to pravastatin vs usual care: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). J Clin Hypertens 2013; 15: 542–54. Baigent C, Landray MJ, Reith C, et al. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet 2011; 377: 2181–92.
www.thelancet.com/diabetes-endocrinology Vol 2 August 2014
