Letter: The Relationship Between Systemic Atherosclerosis and Renal Functions

Dear Editor,

We have read the article by Karayakali et al ¹ entitled “Relationship Between the Severity of Coronary Artery Disease and Renal Function” with great interest. We congratulate the authors for their contribution. We would like to discuss some issues about the relationship between atherosclerosis and renal function.

Karayakali et al ¹ retrospectively included 1181 patients with coronary lesions who underwent elective coronary angiography. A significant relationship was found between coronary atherosclerotic burden and renal dysfunction. While the higher frequency of coronary artery disease in renal patients is an expected finding, the use of the Gensini score increased the value of the study. However, clarifying some points could further enhance the study’s value. The authors stated that “estimated glomerular filtration rate (eGFR) demonstrated a strong correlation with the Gensini score (ρ = −0.352, P < .001).” Considering the correlation coefficient value (ρ = −.352) given in the analysis, it may be more accurate to state that this relationship is weakly significant. ² In addition, the authors considered diabetes as a categorical variable in their study. Rather than the presence of diabetes mellitus, the severity of diabetes may significantly affect coronary atherosclerosis and eGFR values. ³

Atherosclerosis is a systemic disease. The authors determined the degree of coronary atherosclerosis with the Gensini score and noted the lack of evidence of renal atherosclerosis as a limitation. ¹ Considering that the main emphasis of the article is to reveal the relationship between atherosclerotic burden and eGFR, the lack of knowledge about the atherosclerotic burden in other systems of the body can be considered a more important limitation. Atherosclerotic burden in the abdominal aorta, iliac arteries, and carotid arteries, in particular, can also be a determining factor on eGFR. In conclusion, the relationship between peripheral artery disease and renal impairment is a known fact. ⁴ In future research, the total atherosclerotic burden of patients can be calculated with whole-body computed tomography angiography. Thus, clearer interpretations can be made.