Most Patients With CKD Should Take Statins, but Only Half Do

Beth Skwarecki

November 14, 2014

At least 92.0% of patients aged 50 to 79 years with chronic kidney disease (CKD) should be taking statins, according to two different sets of guidelines, researchers report in an article published online November 13 in the Journal of the American Society of Nephrology. Although the American College of Cardiology/American Heart Association (ACC/AHA) guidelines do not consider CKD a risk factor for heart disease, the investigators found that most patients with CKD fit at least one of the criteria. Only 50.0% of the patients studied were already taking statins.

"This finding indicates a high concordance with the 2013 [Kidney Disease Improving Global Outcomes (KDIGO)] Lipid Management guideline, which recommends universal statin treatment for individuals ≥50 years of age with CKD," write Lisandro Colantonio, MD, from the Department of Epidemiology at the University of Alabama at Birmingham, and colleagues.

Patients with CKD face an increased risk for atherosclerotic cardiovascular disease, and randomized trials have shown that statins can reduce mortality risk for patients with CKD who are not receiving dialysis.

The ACC/AHA guidelines, also published in 2013, recommend statins for four groups of patients: adults with a history of atherosclerotic cardiovascular disease, adults with low-density lipoprotein cholesterol of at least 190 mg/dL, adults with low-density lipoprotein cholesterol of 70 to 189 mg/dL if they are aged 40 to 79 years and also have diabetes, and adults with a greater than 7.5% 10-year predicted risk according to Pooled Cohort risk equations.

In the current study, the researchers analyzed data from 4726 patients with CKD from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study to determine how many patients fall into a category in which one guideline recommends they receive statins and the other does not. (The REGARDS study was originally designed to compare stroke risk factors across the United States.) The included patients were not receiving dialysis and were in the age range of 50 to 79 years; the KDIGO guidelines recommend statins for all patients aged 50 years and older, whereas the ACC/AHA guidelines do not recommend initiating statins for primary prevention past age 79 years.

Among the patients, 50.0% were already taking statins, 35.5% had a history of atherosclerotic cardiovascular disease, 39.9% had diabetes, and 3.2% had low-density lipoprotein cholesterol levels of at least 190 mg/dL.

Overall, just 8.0% of the patients did not meet the ACC/AHA criteria to recommend statins. (These patients, because of their age and kidney disease, would all be recommended statins under the KDIGO guidelines.) For 19.8% of the patients, the recommendation to take statins comes from their 10-year risk, as calculated by Pooled Cohort equations.

The study's limitations include the limited follow-up (5 years) for cardiovascular disease events and the possibility that these events are underreported.

"The results from this study suggest that the 2013 KDIGO Lipid Management guideline could lead to unnecessary treatment for only a small percentage of individuals with CKD," the authors write. Because 42% of patients with CKD in this study were not taking statins but should, the authors write that increasing statin use in this population should be a high priority.

Some authors have received grant support from Amgen Inc and Genzyme and honoraria for lectures from Merck Sharp & Dohme and Pfizer.

J Am Soc Nephrol. Published online November 13, 2014. Abstract

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