Kolkailah A, Iskander M, Iskandaer F, Patel P, Khan R, Doukky R. The authors did try to correct for this by performing sensitivity analysis. The authors indicate that 30% of patients underwent renal transplantation during the study which is known to alter outcomes in ESRD patients. A third limitation relates to interfering interventions in prognostic studies. ESRD represents a wide spectrum of patients and it is important to know the causes of renal failure in these patients as well as the duration of the ESRD before the MPI was done. ![]() Another limitation relates to adequate characterization of the study population. This raises the possibility that some of the cardiac deaths have been missed and labeled as non-cardiac death instead, which might explain the relatively low MACE event rates compared to previous studies that the authors commented on. This is somewhat surprising, given that this is a relatively young cohort of patients with a mean age of 54 years. The authors report an overall mortality of 16.6% with only 2.2% attributed to cardiac death. However, few limitations will need to be highlighted.Ī very important limitation relates to definition of endpoints. 2, 3, 4, 5, 6 Given the large sample size, this report will serve as an important reference for future studies looking at the prognostic power of non-invasive cardiac imaging in ESRD patients. The findings are consistent with previous smaller studies looking at Regadenoson as well as other pharmacologic stressors or exercise MPI in patients with ESRD. 1 The group demonstrated a significant incremental prognostic value of Regadenoson MPI in predicting major adverse cardiac events (MACE) in these patients. In this issue of the journal, Kolkailah et al report on the prognostic utility of Regadenoson SPECT myocardial perfusion imaging (MPI) in a large cohort of 1227 patients with ESRD. Hence the role of non-invasive cardiac imaging in providing diagnostic as well as prognostic data in this group of patients is very essential and relevant. These patients carry a particularly high risk for cardiovascular complications. ![]() End Stage Renal Disease (ESRD) is a challenging clinical endpoint for diabetes and hypertension as well as less common primary kidney disorders.
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