Implementation of the KDIGO guideline on lipid management requires a substantial increase in statin prescription rates.
The KDIGO guideline on lipid management in adult patients with chronic kidney disease (CKD) reflects a paradigm shift as proposals for statin use are based on cardiovascular risk rather than cholesterol levels. Statin use is now universally recommended in CKD patients 50 years and older, assuming a 10-year risk of coronary heart disease (CHD) of over 10%. Specific comorbidities or formal risk calculation are required for younger patients. It is unknown to which extent these new guidelines differ from previous practice. Here we analyzed statin use in the German Chronic Kidney Disease study of 5217 adult patients with moderately severe CKD under nephrological care enrolled shortly before publication of the new guideline. Accordingly, 407 patients younger than 50 years would be eligible for statins compared with the 277 patients treated so far, and all 4224 patients 50 years and older would be eligible compared with the 2196 already treated. Overall, guideline implementation would almost double statin prescription from 47 to 88%. Among patients 50 years and older currently not on a statin, an estimated 10-year CHD and atherosclerotic event risks over 10% were present in 68% and 82%, respectively. Thus, implementation of the new lipid guideline requires a substantial change in prescription practice, even in CKD patients under nephrological care. Based on comorbidities and risk estimates, the universal recommendation for statin use in CKD patients 50 years and older appears justified.
Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany.
Markus P
MP
Schneider
Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany.
Silvia
S
Hübner
Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany.
Stephanie I
SI
Titze
Department of Medical Biometry, Informatics and Epidemiology (IMBIE), University of Bonn, Bonn, Germany.
Matthias
M
Schmid
Department of Medical Biometry, Informatics and Epidemiology (IMBIE), University of Bonn, Bonn, Germany.
Jennifer
J
Nadal
Division of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany.
Georg
G
Schlieper
Department of Internal Medicine III, University of Jena, Jena, Germany.
Martin
M
Busch
Department of Nephrology and Medical Intensive Care, Charité Medical University, Berlin, Germany.
Seema
S
Baid-Agrawal
Division of Nephrology, Department of Medicine, University of Würzburg, Würzburg, Germany.
Vera
V
Krane
Division of Nephrology, Department of Medicine, University of Würzburg, Würzburg, Germany.
Christoph
C
Wanner
Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria.
Florian
F
Kronenberg
Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany.
Kai-Uwe
KU
Eckardt