An assessment of cholesterol goal attainment in patients with chronic kidney disease.
BACKGROUND
Patients with chronic kidney disease (CKD) are at significant risk for cardiovascular disease (CVD). The National Kidney Foundation developed clinical practice guidelines (Kidney Disease Outcomes Quality Initiative) for targeting low-density lipoprotein cholesterol (LDL-C) goals.


OBJECTIVE
This study evaluated the extent to which these guidelines were adhered to among patients with CKD and to examine factors associated with the attainment of LDL-C goals.


METHODS
In this cross-sectional study we evaluated patients with a glomerular filtration rate of 15 to 59 mL/min per 1.73 m². Patients with previous CVD, who were receiving dialysis, or were post kidney transplant were excluded. Administrative databases were used to determine the percentage of patients with a fasting lipid profile performed within the previous year, the percentage who attained a LDL-C goal less than 100 mg/dL, and to determine lipid-lowering medications prescribed. Logistic regression analysis was used to identify factors associated with LDL-C goal attainment.


RESULTS
Of the 4541 patients evaluated, 3157 (69.5%) had a fasting lipid profile performed within the previous year. Overall, 60.8% attained a LDL-C less than 100 mg/dL. Among patients at goal, 72.2% were taking lipid-lowering therapy compared with 37.9% of those not at goal (P < .01). Characteristics independently associated with LDL-C goal attainment were increasing age, male gender, increasing chronic disease score, history of diabetes, and statin use.


CONCLUSIONS
Although most patients were screened and attained LDL-C goal, there was room for improvement. Statin use was independently associated with LDL-C goal attainment. Future prospective studies should focus on evaluating clinical outcomes of lipid-lowering interventions within the CKD population.
Pharmacy Department, Kaiser Permanente Colorado, 16601 East Centretech Parkway, Aurora, CO 80011, USA. sheila.l.stadler@kp.org
Sheila L
SL
Stadler
Bharati
B
Bhardwaja
Kari L
KL
Olson
J David
JD
Powers
Diane
D
Lanese
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D008078:Cholesterol, LDL / Q000097:blood*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012044:Regression Analysis; D006435:Renal Dialysis; D012307:Risk Factors; D012737:Sex Factors
D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents