Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease
Authors: Khaled Abdel-Kader
Journal: Annals of Internal Medicine (2014)

Letters1 July 2014Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney DiseaseKhaled Abdel-Kader, MD, MSKhaled Abdel-Kader, MD, MSFrom Vanderbilt University, Nashville, Tennessee.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L14-5013-4 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I appreciate Qaseem and colleagues’ (1) rigor and efforts in producing their guideline on CKD, but a more nuanced view may benefit patients. The authors recommend that clinicians use an ACE inhibitor or ARB in patients with hypertension who have stage 1 to 3 CKD. However, they also recognize that “monotherapy with ACE inhibitors or ARBs statistically significantly reduced the risk for ESRD in patients with CKD, but benefits were limited to patients with macroalbuminuria . ... ” This clarification deserves greater attention and emphasis.Chronic kidney disease is predominantly a disease of older adults who have ...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. Garg AX, Kiberd BA, Clark WF, Haynes RB, Clase CM. Albuminuria and renal insufficiency prevalence guides population screening: results from the NHANES III. Kidney Int. 2002;61:2165-75. [PMID: 12028457] CrossrefMedlineGoogle Scholar3. O'Hare AM, Kaufman JS, Covinsky KE, Landefeld CS, McFarland LV, Larson EB. Current guidelines for using angiotensin-converting enzyme inhibitors and angiotensin II-receptor antagonists in chronic kidney disease: is the evidence base relevant to older adults? Ann Intern Med. 2009;150:717-24. [PMID: 19451579] LinkGoogle Scholar4. Patel SS, Molnar MZ, Tayek JA, Ix JH, Noori N, Benner D, et al. Serum creatinine as a marker of muscle mass in chronic kidney disease: results of a cross-sectional study and review of literature. J Cachexia Sarcopenia Muscle. 2013;4:19-29. [PMID: 22777757] CrossrefMedlineGoogle Scholar5. Lapi F, Azoulay L, Yin H, Nessim SJ, Suissa S. Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study. BMJ. 2013;346:e8525. [PMID: 23299844] CrossrefMedlineGoogle Scholar6. Loboz KK, Shenfield GM. Drug combinations and impaired renal function—the ‘triple whammy’. Br J Clin Pharmacol. 2005;59:239-43. [PMID: 15676048] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Khaled Abdel-Kader, MD, MSAffiliations: From Vanderbilt University, Nashville, Tennessee.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L14-0087. 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 Hiddo J. Lambers Heerspink , Carlo J.A.M. Gaillard , and Ron T. Gansevoort 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 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 Hiddo J. Lambers Heerspink , Carlo J.A.M. Gaillard , and Ron T. Gansevoort Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease Gauranga C. Dhar Metrics 1 July 2014Volume 161, Issue 1Page: 83KeywordsACE inhibitorsAngiotensin receptor blockerCardiovascular therapyChronic kidney diseaseDisclosureDrugsElderlyHypertensionProteinuriaRenal failure ePublished: 1 July 2014 Issue Published: 1 July 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...