Reasons for discontinuation of lipid-lowering medications in patients with chronic kidney disease.
OBJECTIVE
Many patients with chronic kidney disease (CKD) do not receive lipid-lowering therapy despite their high cardiovascular risk. The reasons for this are unknown.


METHODS
We have conducted a retrospective cohort study of discontinuation of lipid-lowering drugs in patients with CKD stage 3 and higher treated in practices affiliated with two academic medical centers between 2000 and 2010. Information on medication discontinuation and its reasons was obtained from electronic medical records, including natural language processing of electronic notes using previously validated software.


RESULTS
Out of 14,034 patients in the study cohort, 10,072 (71.8%) stopped their lipid-lowering drugs at least once, and 2,444 (17.4%) stopped them for at least 1 month. Patients who had a comorbidity associated with higher cardiovascular risk were less likely to stop lipid-lowering drugs. Insurance request was the most common explicitly documented reason for discontinuation, and adverse reactions were the most common reason for long-term discontinuation. In a multivariable analysis, patients were more likely to stop a lipid-lowering drug because of an insurance request if they had government insurance and they were also more likely to stop a lipid-lowering drug because of adverse reactions if they had a history of multiple adverse reactions to other medications. There was no significant relationship between CKD stage and the reason for discontinuation of lipid-lowering drugs.


CONCLUSIONS
Patients with CKD frequently stop lipid-lowering drugs. Insurance requests and adverse reactions are common reasons for the discontinuation. Further research is needed to ensure appropriate lipid-lowering therapy for these individuals at high cardiovascular risk.
Tulane University, New Orleans, La., USA.
Fritha J R
FJ
Morrison
Peking Union Medical College Hospital, Beijing, China.
Huabing
H
Zhang
Stanford University, Stanford, Calif., USA.
Stephen
S
Skentzos
Brigham and Women's Hospital, Boston, Mass., USA.
Maria
M
Shubina
Massachusetts General Hospital, Boston, Mass., USA.
Rhonda
R
Bentley-Lewis
Brigham and Women's Hospital, Boston, Mass., USA.
Alexander
A
Turchin
Chronic kidney disease; Lipid-lowering medications; Medication discontinuation