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We commend O’Hare and colleagues¹ on their recent article demonstrating an association of low ankle-brachial index (ABI) with a prospective rise in serum creatinine concentration in the Atherosclerosis Risk in Communities (ARIC) study. In a cross-sectional analysis of exactly the same data set, our research group also found a significant association of low ABI with kidney disease.²

We have 2 methodological questions for the authors. First, was any attempt made to calibrate the measured serum creatinine concentration to those from the Cleveland Clinic laboratory or from The Third National Health and Nutrition Examination Survey (NHANES III)? Most ARIC analyses with serum creatinine concentration have used a constant of –0.24 to –0.42 mg/dL (–21.2 to –37.1 µmol/L) for measurements from visits 1 and 2. Without calibration, a nondifferential misclassification bias may be present and would tend to bias results toward the null.

Second, was there any significant interaction by race and/or . . . [Full Text of this Article]

AUTHOR INFORMATION
Abhijit V. Kshirsagar, MD, MPH; Romulo E. Colindres, MD, MSPH

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