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Kidney Med
Kidney Med
Kidney Medicine
2590-0595
Elsevier

S2590-0595(24)00096-7
10.1016/j.xkme.2024.100885
100885
Correspondence
Letter to the Editor
The Authors’ Reply to “Revascularization in Peritoneal Dialysis: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting”
Pan Szu-Yu MD, PhD 12
Teng Nai-Chi MSc 3
Chen Likwang PhD 881013nhri@gmail.com
3∗
1 Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
2 Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
3 Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
∗ Address for Correspondence: Likwang Chen, PhD, National Health Research Institutes, No. 35 Keyan Road, Zhunan Town, Miaoli 35053, Taiwan. 881013nhri@gmail.com
08 8 2024
9 2024
08 8 2024
6 9 100885© 2024 The Authors
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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pmcTo the Editor:

We thank Dr Özant Helvacı for his interest in our study.1 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.2,3 Future studies, including a larger population receiving PD and preferably of a prospective randomized controlled design, are warranted to confirm the results.Table 1 Sensitivity Analysis for the Overall Mortality

	HR	95% CI	P Value	
Original model	1.53	1.13-2.08	0.006	
Additional models				
 Cox models censoring at different times				
 1-y mortality	1.27	0.69-2.35	0.45	
 2-y mortality	1.59	1.05-2.43	0.03	
 3-y mortality	1.39	0.93-2.07	0.11	
 4-y mortality	1.74	1.27-2.37	0.001	
 5-y mortality	1.65	1.21-2.25	0.001	
 Survival 90 d after the index revascularization				
 Observation since 90 d after the index date	1.74	1.24-2.46	0.002	
 Two-slope modela	1.76	1.26-2.47	0.001	
 Composite outcome measures				
 Death, ACS, or repeat revascularization	0.89	0.66-1.20	0.44	
 Death or ACS	1.17	0.87-1.56	0.30	
 Death or repeat revascularization	0.92	0.70-1.22	0.56	
Abbreviations: ACS, acute coronary syndrome; HR, hazard ratio.

a The adjusted HR in the second slope (90 days after the index revascularization) was shown.

Article Information

Support

S-YP was supported by the Ministry of Science and Technology (MOST) (106-2314-B-418-006, 107-2314-B-418-001, 108-2314-B-418-004, and 110-2314-B-418-002). LC was supported by the MOST (106-2314-B-400-015) and intramural funding from the National Health Research Institutes, Taiwan.

Financial Disclosure

The authors declare that they have no relevant financial interests.

Acknowledgments

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.

Peer Review

Received May 22, 2024. Accepted June 3, 2024 after editorial review by the Editor-in-Chief.
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References

1 Helvacı Ö. Unveiling nuances in revascularization: a call for focused exploration in peritoneal dialysis patients Kidney Med 6 8 2024 100870 39206247
2 Pan S.Y. Yang J.Y. Teng N.C. Percutaneous coronary intervention with a drug-eluting stent versus coronary artery bypass grafting in patients receiving dialysis: a national study from Taiwan Kidney Med 6 2 2024 100768
3 Tuttle M.L. Weiner D.E. Coronary artery bypass grafting versus percutaneous coronary intervention in patients receiving dialysis: Is CABG worth the risk? Kidney Med 6 2 2024 100787
