Abstract
We thank Raggi et al for their interest in our study and acknowledge their broad agreement that measuring coronary artery calcification by EBCT has not yet been shown to be predictive of obstructive coronary artery disease in dialysis patients. It was not the aim of our study to examine the relationship between coronary artery calcification and cardiovascular risk. These studies are lacking. The only study prospectively to examine the relationship between vascular calcification and mortality1London G.M Guerin A.P Marchais S.J Metivier F Pannier B Adda H Arterial media calcification in end-stage renal disease Impact on all cause and cardiovascular mortality .Nephrol Dial Transplant. 2003; 18: 1731-1740Google Scholar used soft tissue native radiographs, emphasizing the need for longitudinal studies to assess the natural history and outcome of coronary artery calcification observed with EBCT or by other techniques. This will also allow objective comparison of the imaging techniques available. We whole-heartedly agree that vascular calcification is a major contributor to cardiovascular deaths in dialysis patients (albeit not demonstrably via an association with obstructive coronary artery disease), and that the prevention of this calcification is one of the most important goals in nephrology. However, there are no randomized controlled trials that tell us how that can be achieved, although the “Treat to Goal” results suggest that the more limited objective of prevention of progression may be achievable by avoidance of calcium-based phosphate binders. We should not forget that vascular calcification was common before the widespread use of calcium-based phosphate binders2Qunibi W.Y Nolan C.A Ayus J.C Cardiovascular calcification in patients with end-stage renal disease A century-old phenomenon .Kidney Int Suppl. 2002; 62: S73-S80Google Scholar and is a complex, regulated process.3Hujairi N.M.A Afzali B Goldsmith D.J.A Cardiac calcification in renal patients What we do and don't know .Am J Kidney Dis. 2004; 43: 234-243Abstract Full Text Full Text PDF Scopus (70) Google Scholar The available results of intervention trials with sevelamer4Chertow G Burke S Raggi P Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients.Kidney Int. 2002; 62: 245-252Google Scholar are an interesting start to a complex story.
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