The Authors’ Reply to “Revascularization in Peritoneal Dialysis: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting”

We thank Dr Özant Helvacı for his interest in our study.1Helvaci Ozant Unveiling nuances in revascularization: a call for focused exploration in peritoneal dialysis patients.Kidney Med. 2024; 6100870https://doi.org/10.1016/j.xkme.2024.100870Abstract Full Text Full Text PDF Google Scholar We agree that revascularization strategies in patients receiving peritoneal dialysis (PD) deserve further attention. From the 4,165 patients receiving dialysis hospitalized for revascularization in our cohort, we selected 333 (8.0%) PD patients receiving either coronary artery bypass grafting (CABG) (86 patients [25.8%]) or percutaneous coronary intervention (PCI) with drug-eluting stent (DES) (247 patients [74.2%]) for further analysis. Inverse probability of treatment weighting was used to balance the baseline characteristics. Compared with patients receiving PCI with DES, the risk of in-hospital mortality was significantly higher in patients receiving CABG (adjusted odds ratio, 5.70; 95% confidence interval [CI], 1.42-22.83; P = 0.01). The overall mortality was also significantly higher in patients receiving CABG (adjusted hazard ratio, 1.53; 95% CI, 1.13-2.08; P = 0.006). The long-term mortality hazard associated with CABG remained consistent in several sensitivity analyses (Table 1). Notably, the hazards associated with CABG became insignificant when the outcome included repeat revascularization, subsequent acute coronary syndrome, or both, in addition to death. This might indicate a risk of incomplete revascularization linked to PCI with DES. Based on these results, we conclude that CABG was associated with both higher in-hospital and long-term mortality than PCI with DES in our national cohort of Taiwan patients receiving PD. However, we are aware of the limitations of our study.2Pan S.Y. Yang J.Y. Teng N.C. et al.Percutaneous coronary intervention with a drug-eluting stent versus coronary artery bypass grafting in patients receiving dialysis: a national study from Taiwan.Kidney Med. 2024; 6100768Abstract Full Text Full Text PDF Scopus (1) Google Scholar,3Tuttle M.L. Weiner D.E. Coronary artery bypass grafting versus percutaneous coronary intervention in patients receiving dialysis: Is CABG worth the risk?.Kidney Med. 2024; 6100787Abstract Full Text Full Text PDF Scopus (0) Google Scholar Future studies, including a larger population receiving PD and preferably of a prospective, randomized controlled design, are warranted to confirm the results.Table 1Sensitivity Analysis for the Overall MortalityHR95% CIP ValueOriginal model1.531.13-2.080.006Additional models Cox models censoring at different times1-y mortality1.270.69-2.350.452-y mortality1.591.05-2.430.033-y mortality1.390.93-2.070.114-y mortality1.741.27-2.370.0015-y mortality1.651.21-2.250.001 Survival 90 d after the index revascularizationObservation since 90 d after the index date1.741.24-2.460.002Two-slope modelaThe adjusted HR in the second slope (90 days after the index revascularization) was shown.1.761.26-2.470.001 Composite outcome measuresDeath, ACS, or repeat revascularization0.890.66-1.200.44Death or ACS1.170.87-1.560.30Death or repeat revascularization0.920.70-1.220.56Abbreviations: ACS, acute coronary syndrome; HR, hazard ratio.a The adjusted HR in the second slope (90 days after the index revascularization) was shown. Open table in a new tab Abbreviations: ACS, acute coronary syndrome; HR, hazard ratio. None. The authors declare that they have no relevant financial interests. We thank the Applied Health Research Data Integration Service from the Taiwan National Health Insurance Administration for the provision of the National Health Insurance Research Database. Received May 22, 2024. Accepted June 3, 2024 after editorial review by the Editor-in-Chief. Unveiling Nuances in Revascularization: A Call for Focused Exploration in Peritoneal Dialysis PatientsKidney MedicineVol. 6Issue 9PreviewWe appreciate the comprehensive study conducted by Pan et al1 comparing percutaneous coronary intervention (PCI) with a drug-eluting stent versus coronary artery bypass grafting (CABG) in patients receiving dialysis. The authors presented compelling data suggesting that CABG may not be superior and could pose potential harm compared with PCI.