Examination of statin use in relation to guidelines reveals underuse in CKD patients
Differing statin guidelines are fairly concordant on use of the drugs in adults with chronic kidney disease (CKD), a study found.
Differing statin guidelines are fairly concordant on use of the drugs in adults with chronic kidney disease (CKD), a study found.
Researchers looked at the guidelines developed by the Kidney Disease Improving Global Outcomes (KDIGO) Lipid Work Group and the American College of Cardiology/American Heart Association (ACC/AHA) for adults 50 to 79 years old with CKD (defined as estimated glomerular filtration rate [eGFR]<60 mL per min per 1.73 m2 or albuminuria ≥30 mg/g) who were not on dialysis.
The 2 groups' recommendations for statin use differ. KDIGO recommends statins for adults with CKD who are 50 years or older. The ACC/AHA endorses statins for adults with atherosclerotic cardiovascular disease (ASCVD), adults with LDL cholesterol above 190 mg/dL, and adults 40 to 79 years old with LDL cholesterol of 70 to 189 mg/dL and diabetes or a 10-year predicted risk for ASCVD of 7.5% or greater estimated using published pooled cohort risk equations.
Researchers assessed the agreement for statin treatment between the 2 guidelines using data from the Reason for Geographic and Racial Differences in Stroke Study (REGARDS), which enrolled patients between 2003 and 2007 and reported stroke and coronary heart disease through December 2010. Among 4,726 participants with CKD, 2,366 (50%) were taking statins, 1,984 (42%) met the ACC/AHA guideline criteria for statins but were not taking them, and 376 (8%) did not meet the ACC/AHA criteria for taking statins. Cardiovascular disease incidence was low (3/1,000 person-years; 95% CI, 0.1 to 5.9) in that group.
Results appeared online Nov. 13 at The Journal of the American Society of Nephrology.
The researchers concluded that KDIGO guidelines could lead to unnecessary treatment for only a small percentage of CKD patients and that 42% of patients who were recommended statins were not taking them. “Statin use increased markedly after the universal recommendations of statins for individuals with diabetes,” they wrote. “Given the high ASCVD risk for individuals with CKD, increasing the appropriate use of statins in this population should be a high priority.”