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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.

While a mass-mailing campaign bypassing the physician is appealing, it would also have potential disadvantages. First, implementation of such a campaign is more likely to be feasible in locales with population-oriented health care infrastructures that can support such efforts. It is not clear . . . [Full Text of this Article]

L. Ebony Boulware, MD, MPH; Bernard G. Jaar, MD, MPH; Neil R. Powe, MD, MPH, MBA
Johns Hopkins Medical Institutions
Baltimore, Md

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