Hiddo J. Lambers Heerspink, PhD; Carlo J.A.M. Gaillard, MD, PhD; Ron T. Gansevoort, MD, PhD
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L14-0088.
Lambers Heerspink HJ, Gaillard CJ, Gansevoort RT. Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease. Ann Intern Med. 2014;161:82-83. doi: 10.7326/L14-5013-3
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Published: Ann Intern Med. 2014;161(1):82-83.
TO THE EDITOR:
Qaseem and colleagues’ guideline (1) recommends against testing for proteinuria in adults with or without diabetes who are currently receiving an ACE inhibitor or ARB. We believe that this is an erroneous recommendation not supported by literature and, if implemented in clinical practice, a step backward with respect to achieving optimal patient care.
Several trials in populations with different causes of kidney disease have shown that ACE inhibitors and ARBs decrease proteinuria in a dose-dependent manner (2). Furthermore, randomized, controlled trials indicate that these agents are renoprotective. In these trials, the magnitude of the decrease in albuminuria induced by ACE inhibitors or ARBs is the most important determinant of the long-term renoprotective benefit (3), independent of changes in blood pressure. In addition, residual albuminuria during therapy with ACE inhibitors or ARBs is associated with long-term outcomes (3).
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