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| Year : 2011 | Volume
: 22
| Issue : 1 | Page : 158-159 |
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| Author's Reply |
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Aimun Ahmed
Consultant Nephrologist, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, United Kingdom
Click here for correspondence address and email
| Date of Web Publication | 30-Dec-2010 |
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How to cite this article:
Ahmed A. Author's Reply. Saudi J Kidney Dis Transpl 2011;22:158-9 |
To the Editor,
I have read with confusion the letter sent to you commenting on my paper. Clearly, the author/authors of this letter did not read my paper that was published in your journal carefully. He is criticizing things that are not there. I regret to say that I do not accept these comments and I think that it is a waste of our and your time going through that letter.
There was no mention in my review that 59 mL/min/1.73 m2 eGFR is the cut-off value that differentiates out age-related from pathological decline in GFR.
It is well known that there are limitations of the MDRD equation in the estimation of GFR, and one of its limitations is that it is not accurate when GFR is near to normal; hence, most of the Labs in the UK report eGFR when it is the range of CKD 1 and 2 as >60 mL/min. The KDOQI classifies the CKD stages 1 and 2 with a must of other evidence of kidney damage.
I am surprised by the comment saying that we "overlooked the repeated finding of losing the association between cardiovascular disease (CVD) and GFR decline among CKD3 patients in the absence of microalbuminuria''. We have clearly stated that in the Prevention of Renal and Vascular End Stage Disease (PREVEND) study, patients with macroalbuminuria, defined as ≥300 mg albumin/24 H urine, showed a -7.2 mL/min/1.73 m2 GFR loss compared with -2.3 mL/min/1.73 m 2 in the control group (P < 0.001). [1]
We have also stressed that in the MRFIT study, the risk of developing a renal event was 12-folds in patients with CKD stage 1 with microalbuminuria as compared with patients with no CKD (95% CI, 10.3-23.9). The risk was only 2.4-folds in CKD stage 3 patients without micoalbuminuria (95% CI, 1.5-3.8), which increased to 41-folds in CKD stage 3 patients with microalbuminuria (95% CI, 15.2- 71.1). [2] Thus, clearly, our review was not read and was just criticized!
We also clearly quoted a large study from the United States of 27,998 patients with GFR <90 mL/min/1.73 m2 followed-up for 5 years, where the rate of renal replacement therapy initiation was 1.1%, 1.3% and 19.9%, respectively, for CKD stages 2, 3 and 4. The average age in that study was above 61 years for all the stages. [3]
Again, we were right in quoting that 1.2% (38 out of the 3069) of the people with CKD in the Norwegian prospective study progressed to ESRD. [4] I am not sure from where the authors of this letter brought the 0.1% figure.
Regarding the rest of the letter, I do not want to comment on many parts that are not related to my paper, especially when the author is mentioning his own practice. Clearly, our practices are so different as are our interpretations of clear facts in the literature and misreading numbers in the published data.
Finally, I would like to take the chance to thank you for the time you have given to our paper and I hope that we will collaborate in the near future with more manuscripts.
 References | |  |
| 1. | Halbesma N, Kuiken DS, Brantsma AH, et al. Macroalbuminuria is a better risk marker than low estimated GFR to identify individuals at risk for accelerated GFR loss in population screening. J Am Soc Nephrol 2006;17:2582-90. 
[PUBMED] [FULLTEXT] |
| 2. | Ishani A, Grandits GA, Grimm RH, et al. Association of single measurements of dipstick proteinuria, estimated glomerular filtration rate, and haematocrit with 25-year incidence of end stage renal disease in the multiple risk factor intervention trial. J Am Soc Nephrol 2006;17: 1444-52.
[PUBMED] [FULLTEXT] |
| 3. | Keith DS, Nichols GA, Gullion CM, et al. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med 2004;164:659-63.
[PUBMED] [FULLTEXT] |
| 4. | Hallan SI, Dahl K, Oien CM, et al. Screening strategies for chronic kidney disease in the general population: follow-up of cross sectionnal health survey. Br Med J 2006;333:1047-53.
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Correspondence Address:
Aimun Ahmed
Consultant Nephrologist, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston
United Kingdom
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