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March 2009

Medications Impair Kidney Function in Stroke Population—Reply

Arch Neurol. 2009;66(3):416-421. doi:10.1001/archneurol.2009.3

In reply

I thank Dr Kittisupamongkol for the interest in my study. I am unclear about the nature of the comment in the letter pertaining to the metabolic syndrome. The point about the influence of certain medications traditionally used in vascular risk reduction on kidney function is well taken, but I have to disagree with the notion that such effects are necessarily deleterious. Indeed, most patients with chronic kidney disease (CKD) tend to die of cardiovascular causes and not progression to end-stage renal disease. Thus, it is generally recommended that health care practitioners aim to lower vascular risk, a strategy that often requires the use of several widely prescribed medications such as statins, antiplatelet therapies, and modulators of the rennin-angiotensin system.1 Rennin-angiotensin system modulators such as angiotensin-converting enzyme inhibitors may actually improve clinical outcomes in many patients with CKD.2-4 Other studies have shown no signs of toxic effects from statin and aspirin therapy in patients with CKD.5,6 Furthermore, given the evidence provided in meta-analyses and guideline recommendations indicating the superior efficacy of low- to moderate-dose aspirin for persons with high vascular risk (including patients with stroke) and the well-known greater risk of systemic hemorrhages with high doses,7,8 relatively few individuals currently receive high doses of aspirin to lower vascular risk. The presence of renal impairment in the setting of using most of these agents more likely represents true CKD.1

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