Saudi Journal of Kidney Diseases and Transplantation

: 2021  |  Volume : 32  |  Issue : 1  |  Page : 274--275

Author’s Reply

Abeera Mansur, Shahbaz Sarwar 
 Department of Nephrology, Doctors Hospital and Medical Center, Lahore, Pakistan

Correspondence Address:
Abeera Mansur
Department of Nephrology, Doctors Hospital and Medical Center, Lahore

How to cite this article:
Mansur A, Sarwar S. Author’s Reply.Saudi J Kidney Dis Transpl 2021;32:274-275

How to cite this URL:
Mansur A, Sarwar S. Author’s Reply. Saudi J Kidney Dis Transpl [serial online] 2021 [cited 2022 Jan 19 ];32:274-275
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Full Text

To the Editor,

The study “Echocardiographic Evaluation of Left Atrial Volume Index (LAVi) in Patients with Chronic Kidney Disease (CKD)” was designed to evaluate non-CKD versus CKD patients. Majority of the CKD patients had underlying hypertension, diabetes mellitus and ischemic heart disease.

The mean eGFR in our population was 28.8 ± 7.42 mL/min as compared to the study done by El-Sherbeny and Elhefnawy.[1] In this study the CKD population was from stages 2 and 3. Thus, they were not able to show a significant difference between the LAVi of hypertensive and CKD patients.

In the study by Nakanishi et al[2] there was no significant difference in LAVi between the CKD and non-CKD group. The mean eGFR was 50 ± 9 mL/min/1.73 m2 which is a higher eGFR than in our study population.

We have shown that LAVi increased as eGFR declined and CKD advanced [Figure 1] and [Figure 2]. Thus, the lack of correlation of eGFR with LAVi in these studies could be attributed to an earlier CKD stage of the study population. LAVi was also found to be significantly larger (33 ± 12 mL/m2 vs. 27±10 mL/m2; P = 0.001) in a study where the mean eGFR of the CKD population was 41 mL/min.3

Although we did not have separate study groups of non CKD diabetic, hypertensive and IHD patients, the non-CKD and CKD patients who had the above showed a correlation that was not as strong as that of CKD with LAVI.

As suggested in our paper, future studies, with a larger number of patients, including both CKD stages 3–5 and CKD 5D and adjusting for other clinical and echocardio-graphic parameters, are warranted. Similarly, addition of LA Global Strain and Strain Rate, may also be helpful in identifying, sub-groups of CKD patients with earlier changes.


1El-Sherbeny WS, Elhefnawy SB. Left atrial function and volume an independent markers of cardiovascular involvement in early chronic kidney disease. Int J Cardiovasc Res 2019;8:2.
2Nakanishi K, Jin Z, Russo C, et al. Association of chronic kidney disease with impaired left atrial reservoir function: A community-based cohort study. Eur J Prev Cardiol 2017;24:392-398.
3Hee L, Nguyen T, Whatmough M, et al. Left atrial volume and adverse cardiovascular outcomes in unselected patients with and without CKD. Clin J Am Soc Nephrol 2014;9:1369-76.