Guidelines say nearly all patients with chronic kidney disease should take statins

November 13, 2014

Highlights More than 20 million US adults have chronic kidney disease.

Washington, DC (November 13, 2014) -- Almost all people with pre-dialysis kidney disease should receive statins by current guidelines, reports a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).

Because individuals with chronic kidney disease (CKD) have an increased risk for developing heart disease, preventive measures such as maintaining normal cholesterol levels are important. In 2013, two cholesterol management guidelines were published: one by the American College of Cardiology/American Heart Association (ACC/AHA) and another by the Kidney Disease Improving Global Outcomes Lipid Work Group (KDIGO). The ACC/AHA guideline recommends statin treatment for individuals with a high heart disease and stroke risk based on having a history of heart problems, diabetes, or very high cholesterol, or for those with an estimated 10-year risk ≥7.5% using a formula called the "Pooled Cohorts risk equations". In contrast, the KDIGO guideline recommends statin therapy for all individuals 50 to 79 years of age with CKD.

Although individuals with CKD are in general more likely to develop heart disease than individuals without CKD, some may be considered at low risk by the ACC/AHA cholesterol treatment guideline. So which guideline should these patients follow?

To investigate, Lisandro Colantonio, MD, MSc, Paul Muntner, PhD (University of Alabama at Birmingham School of Public Health) and their colleagues compared the two treatment recommendations using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a large study of more than 30,000 US adults.

Among the major findings:"These results indicate that either guideline can be used to inform the decision to initiate statin therapy for people with CKD who are 50 to 79 years of age," said Dr. Colantonio. "They also show that there is an unmet treatment need and a missed opportunity for lowering heart disease risk among patients with CKD." Dr. Colantonio notes that "The accuracy of the pooled cohort risk equations in people with CKD is important given their high risk for heart disease and stroke. Physicians can use this tool in guiding therapy for patients with CKD."
Study co-authors include Usman Baber, MD, Maciej Banach, MD, PhD, Rikki Tanner, MPH, David Warnock, MD, Orlando Gutiérrez, MD, Monika Safford, MD, Christoph Wanner, MD, and George Howard, DrPH.

Disclosures: Drs. David Warnock, Monika Safford and Paul Muntner have received grant support from Amgen Inc. Dr. Lisandro Colantonio was funded with a Fulbright Scholarship to complete the PhD program in Epidemiology from the University of Alabama at Birmingham.

The article, entitled "Contrasting Cholesterol Management Guidelines for Adults with CKD," will appear online at on November 13, 2014.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 15,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

American Society of Nephrology

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