How are the cardiovascular risks associated with chronic kidney disease (CKD) managed?

Updated: Oct 26, 2020
  • Author: Pradeep Arora, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Guidelines issued in December 2013 by the Kidney Disease: Improving Global Outcomes (KDIGO) workgroup recommend wider statin use among patients with CKD. Specific recommendations include the following [83, 84] :

  • Adults aged 50 years or above with an estimated glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2 who are not being treated with long-term dialysis or kidney transplantation should be treated with a statin or a statin plus ezetimibe

  • Treatment with statins or statin/ezetimibe should not be initiated in adults with dialysis-dependent CKD

  • Patients already being treated with a statin at the time of dialysis should continue

  • Adult kidney transplant patients should be treated with a statin because of an increased risk for coronary events

  • Adults aged 18-49 years with an estimated GFR of less than 60 mL/min/1.73 m2 who are not being treated with dialysis or kidney transplantation should be treated with statins if they have coronary disease, diabetes, prior ischemic stroke, or an estimated 10-year risk of coronary death or nonfatal myocardial infarction exceeding 10%

  • Low-density lipoprotein cholesterol is an insufficient test for cardiovascular risk in individuals with CKD, and adults with newly diagnosed CKD should undergo lipid profile testing

  • Adults aged 50 years or older with CKD and an estimated GFR of 60 mL/min/1.73 m2 or higher should be treated with a statin

Patients with CKD may require anticoagulation for a variety of indications, such as atrial fibrillation, venous thromboembolism, or prevention of dialysis access thrombosis. A systematic review and meta-analysis of oral anticoagulation in adult patients with CKD concluded that in early-stage CKD, the benefit-risk profile of non–vitamin K oral anticoagulants (NOACs; ie, dabigatran, rivaroxaban, apixaban, edoxaban) was superior to that of vitamin K antagonists (eg, warfarin). [85]

In the study, which included 45 randomized trials of oral anticoagulation strategies in 34,082 patients with either chronic or dialysis-dependent kidney disease, NOACs provided better prevention of stroke and systemic embolism in CKD patients with atrial fibrillation and early-stage disease. In CKD patients with advanced or end-stage disease, however, the authors found insufficient evidence to recommend wide use of either class of anticoagulants to improve outcomes. Low-certainty evidence suggested lower risk of major bleeding with NOACs versus vitamin K antagonists. [85]


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