Use of Statins in Patients with Non-Dialysis Dependent CKD

New Orleans—Among adults with non-dialysis dependent chronic kidney disease (CKD), morbidity and mortality is strongly associated with cardiovascular disease. The risk of atherosclerotic cardiovascular disease is significantly reduced with the use of statins, especially when combined with ezetimibe, in this patient population.

Renal guidelines call for use of statins in all patients with non-dialysis dependent CKD ≥50 years of age regardless of lipid profile. However, recent recommendations from the American Heart Association/American College of Cardiology for statin use for adults, including those with CKD, in the absence of atherosclerotic cardiovascular disease or diabetes are based on predicted 10-year risk for atherosclerotic cardiovascular disease risk derived from the pooled risk cohort equation.

David J. Leehey, MD, and colleagues recently conducted a retrospective review designed to examine statin utilization in a national sample of US veterans with non-dialysis dependent CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2). The researchers also sought to calculate the predicted risk for atherosclerotic cardiovascular disease by diabetes status using the pooled risk cohort equation. Study results were reported during a poster session at Kidney Week 2017 in a poster titled Low Utilization of Statins in US Veterans with Non-Dialysis Dependent CKD.

The study included 581,344 veterans ≥50 years of age with non-dialysis dependent CKD stages 3 to 5 receiving care at VA Healthcare facilities, with no history of kidney transplantation or dialysis use. Statin use was determined from pharmacy dispensing records for fiscal years 2012 and 2013.

Of the 581,344 study participants, 97% were male and 58% were >70 years of age. Statin use ranged considerably, from as high as 76% among patients with atherosclerotic cardiovascular disease or diabetes to as low as 22% among participants without those conditions (P<.001). Overall, 94% of those without diabetes and 97% of those with diabetes had an atherosclerotic cardiovascular disease risk score >7.5%; of those, 42% had no statin use. Among those with a very high atherosclerotic cardiovascular disease risk score, defined as ≥20%, only 52% of CKD patients without diabetes and 75% of CKD patients with diabetes were using statins.

“Utilization of statins is low in veterans with non-dialysis dependent CKD in the absence of well-known indications for statin use (ie, atherosclerotic cardiovascular disease or diabetes) despite high-predicted atherosclerotic cardiovascular disease risk. We conclude that whether one follows renal or cardiovascular guidelines, statin utilization is suboptimal in CKD patients. National education efforts will be needed to increase statin use in CKD, especially in patients without established atherosclerotic cardiovascular disease or diabetes,” the researchers said.

Source: Leehey DJ, Markossian T, Burge N, et al. Low utilization of statins in US veterans with non-dialysis dependent CKD. Abstract of a poster presented at the American Society of Nephrology 2017 Kidney Week, November 2, 2017, New Orleans, Louisiana.