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To the Editor: Dr Hsu and colleagues¹ concluded that apolipoprotein E (APOE) gene variation predicted chronic kidney disease progression, independent of diabetes, race, lipid, and nonlipid factors. The authors state that the APOE association with chronic kidney disease progression was not explained by established kidney disease risk factors including diabetes and hypertension.

In their study, 56.3% of African American participants and 32.0% of white participants were classified as having hypertension. Some types of antihypertensive drugs, such as angiotensin-converting enzyme (ACE) inhibitors² or angiotensin receptor blockers (ARBs),³ slow progression of chronic kidney disease independent of their blood pressure–lowering effect. It is therefore important to know the proportion of patients using ACE inhibitors or ARBs in each APOE genotype group before reaching the conclusion that APOE genotype independently predicts chronic kidney disease progression.

Financial Disclosures: None reported.

Yujiro Kida, MD, PhD
Department of Anatomy II
Tsurumi University
School of Dental Medicine
Yokohama, Japan

1. Hsu CC, Kao WHL, Coresh J, et al. Apolipoprotein E and progression of chronic kidney disease. JAMA. 2005;293:2892-2899. FREE FULL TEXT 2. Jafar TH, Schmid CH, Landa M, et al. Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. Ann Intern Med. 2001;135:73-87. FREE FULL TEXT 3. Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345:851-860. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;295:35.

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