To the Editor.—On the surface, the recent article by Abraham and colleagues1 would seem to address a provocative question: whether or not the progression of nondiabetic chronic renal disease can be affected by the administration of the angiotensin-converting enzyme inhibitor (ACEI) enalapril. Closer inspection reveals little data concerning this patient group. Of the 10 patients able to complete short-term therapy, 4 actually had diabetic nephropathy and only 2 of the 6 patients with nondiabetic renal disease had significant proteinuria (Nos. 4 and 10). Only 1 of these 2 patients (No. 4) seemed to have a significant reduction in proteinuria, but he was withdrawn from the study before the long-term phase of the study could be completed. The authors state that "the rate of progression of renal insufficiency seemed to slacken in 3 of 4 patients with diabetic nephropathy," based on changes in slopes of serum creatinine curves (the
WOLFE CMW, SAAD CRM. Efficacy and Renal Effects of Enalapril Therapy for Hypertensive Patients With Chronic Renal Insufficiency. Arch Intern Med. 1989;149(6):1462–1463. doi:10.1001/archinte.1989.00390060166044
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