Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: In response to Dr Gansevoort and
colleagues, we thought it premature at the time of our study to conduct analyses
of screening aimed at detecting microalbuminuria. This decision was based
on the lack of data on progression rates of chronic kidney disease for persons
with microalbuminuria but with neither hypertension nor diabetes, as well
as the limited data demonstrating the magnitude of risk reduction in events
afforded by the use of ACE inhibitors in such persons. A definitive study
on the effect of ACE inhibitor therapy on chronic kidney disease progression
rates and the development of cardiovascular events in this population would
make this possible.
Boulware LE, Jaar BG, Powe NR. Cost-effectiveness of Screening for Proteinuria—Reply. JAMA. 2004;291(12):1442-1443. doi:10.1001/jama.291.12.1443-a