Most older persons with predialysis chronic kidney disease (CKD) should take statins, indicate the findings of a study published byJournal of the American Society of Nephrology.
Two guidelines on cholesterol management in CKD were compared — one from the American College of Cardiology and the American Heart Association (ACC/AHA) and the other from the Kidney Disease Improving Global Outcomes (KDIGO) Lipid Work Group.
Using data from the Reasons for Geographic and Racial Differences in Stroke Study, lead author Lisandro Colantonio, MD, MSc, and fellow investigators compared the statin treatment recommendations in the two guidelines among more than 30,000 U.S. adults aged 50 to 79 years. All participants had CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2 or albuminuria ≥30 mg/g) but were not on dialysis.
The major findings of the study were as follows:
The guidelines agree that nearly all persons aged 50 to 79 years with CKD should be on a statin regimen (92%, according to the ACC/AHA guideline; 100%, according to the KDIGO guideline).
Half (50%) of all persons with CKD in the study who should have been taking statins according to these guidelines, were not.
Pooled cohort risk equations, which can estimate a 10-year predicted risk for atherosclerotic cardiovascular disease of 7.5% or more, offer moderately good discrimination for clinicians to use it as a tool to estimate risk for heart disease, and thereby guide therapy, in persons with CKD.