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The concept of impaired “organ reserve” as a determinant of cardiovascular and all-cause survival proposed by Dr. Manhapra is an important one. Through normative aging, data from the National Health and Nutrition Examination Survey indicated that the estimated glomerular filtration rate (eGFR) does not dip below 60 ml/min/1.73 m2through age 85 (Fig. 1). Hence, an eGFR <60 ml/min/1.73 m2indeed represents impaired renal organ reserve, and remnant nephrons must pick up a higher filtration and metabolic workload. Thus, at this level, we can expect a different metabolic milieu that accelerates atherosclerosis, valvular disease, heart failure, and arrhythmias, which invariably leads to higher rates of cardiac and noncardiac death. Having recognized chronic kidney disease (or impaired renal organ reserve) as an independent cardiovascular risk state, the real challenges now are to develop new diagnostic and therapeutic targets to better care for this rapidly growing segment of our cardiovascular population.
- American College of Cardiology Foundation