Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease
Authors: Hiddo J. Lambers Heerspink, Carlo J.A.M. Gaillard, Ron T. Gansevoort
Journal: Annals of Internal Medicine (2014)

Letters1 July 2014Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney DiseaseHiddo J. Lambers Heerspink, PhD, Carlo J.A.M. Gaillard, MD, PhD, and Ron T. Gansevoort, MD, PhDHiddo J. Lambers Heerspink, PhDFrom University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.Search for more papers by this author, Carlo J.A.M. Gaillard, MD, PhDFrom University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.Search for more papers by this author, and Ron T. Gansevoort, MD, PhDFrom University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L14-5013-3 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail 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 ...References1. Qaseem A, Hopkins RH, Sweet DE, Starkey M, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Screening, monitoring, and treatment of stage 1 to 3 chronic kidney disease: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2013;159:835-47. [PMID: 24145991] LinkGoogle Scholar2. Gansevoort RT, de Zeeuw D, de Jong PE. Is the antiproteinuric effect of ACE inhibition mediated by interference in the renin-angiotensin system? Kidney Int. 1994;45:861-7. [PMID: 8196289] CrossrefMedlineGoogle Scholar3. Heerspink HJ. Therapeutic approaches in lowering albuminuria: travels along the renin-angiotensin-aldosterone-system pathway. Adv Chronic Kidney Dis. 2011;18:290-9. [PMID: 21782135] CrossrefMedlineGoogle Scholar4. Hou FF, Xie D, Zhang X, Chen PY, Zhang WR, Liang M, et al. Renoprotection of Optimal Antiproteinuric Doses (ROAD) Study: a randomized controlled study of benazepril and losartan in chronic renal insufficiency. J Am Soc Nephrol. 2007;18:1889-98. [PMID: 17494885] CrossrefMedlineGoogle Scholar5. Witte EC, Lambers Heerspink HJ, de Zeeuw D, Bakker SJ, de Jong PE, Gansevoort R. First morning voids are more reliable than spot urine samples to assess microalbuminuria. J Am Soc Nephrol. 2009;20:436-43. [PMID: 19092125] CrossrefMedlineGoogle Scholar6. Incidence, prevalence, patient characteristics and treatment modalities. In: U.S. Renal Data System. 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2013:215-28. Accessed at www.usrds.org/2013/pdf/v2_ch1_13.pdf on 25 November 2013. Google Scholar7. Rensma PL, Hagen EC, Wetzelfs JFM, Kaasjager HAH, Ter Wee PM, Smulders YM. [Dutch Guideline Chronic Renal Failure.] Utrecht, the Netherlands: Kwaliteitskoepel; 2009. Accessed at www.kwaliteitskoepel.nl/assets/structured-files/NIV/Betrokkenbij/Chronische-nierschade-2009.pdf on 25 November 2013. Google Scholar Author, Article, and Disclosure InformationAffiliations: From University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L14-0088. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHigh-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate the Benefits, Harms, and Costs of Medical Interventions Douglas K. Owens , Amir Qaseem , Roger Chou , Paul Shekelle , and Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease Gauranga C. Dhar Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease Adeera Levin , Paul E. Stevens , Josef Coresh , and Andrew Levey Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease Khaled Abdel-Kader Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease Amir Qaseem , Timothy Wilt , and Thomas D. Denberg Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease Khaled Abdel-Kader Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease Amir Qaseem , Timothy Wilt , and Thomas D. Denberg Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease Adeera Levin , Paul E. Stevens , Josef Coresh , and Andrew Levey Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease Gauranga C. Dhar Metrics Cited ByHigh sensitivity detection of human serum albumin using a novel magnetoelastic immunosensorReducing the costs of chronic kidney disease while delivering quality health care: a call to action 1 July 2014Volume 161, Issue 1Page: 82-83KeywordsACE inhibitorsBlood pressureDisclosurePatientsPopulation statisticsProteinuriaRenal diseasesRenal failureTreatment guidelines ePublished: 1 July 2014 Issue Published: 1 July 2014 CopyrightCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...