Lipid management in CKD patients has ‘room for improvement’
MedWire News: Lipid levels are being managed in line with guideline recommendations in the majority of patients with chronic kidney disease (CKD), study results show.
However, the survey of over 4500 CKD patients found that although the majority were screened and attained lipid goals, there was still "room for improvement."
Patients with CKD are at significant risk for cardiovascular disease, and guidelines from the US National Kidney Foundation recommend annual screening and a low-density lipoprotein (LDL) cholesterol goal of less than 100 mg/dl (2.59 mmol/l) for patients with stages 1 to 5 CKD.
In this study, Sheila Stadler (Kaiser Permanente Colorado, Denver, USA) and team assessed the degree of adherence to these recommendations in real-world clinical practice.
They identified a total of 4541 individuals aged 18 years or over with a glomerular filtration rate below 60 ml/min/1.73 m2 between January 2002 and December 2005. None had known cardiovascular disease or were on dialysis.
Nearly seven in 10 (69.5%) had had a fasting lipid profile performed within the previous year and 60.8% had attained the LDL cholesterol goal of less than 100 mg/dl (2.59 mmol/l), report Stadler and colleagues in the Journal of Lipid Research.
Among the patients at goal, 72.2% were taking pharmacologic lipid-lowering therapy. By comparison, just 37.9% of those not at goal were taking such therapy.
In multivariate analysis, characteristics that were independently associated with attainment of lipid goals were increasing age, male gender, increasing chronic disease score, diabetes, and the use of statins.
Indeed, use of statins was associated with a nearly five-fold greater likelihood of attaining the LDL cholesterol goal, the authors comment.
They say their results reveal a "treatment gap" between the proportion of patients being screened for lipids (69.5%) and the proportion being treated to goal (60.8%).
"While these results are higher than have been reported previously, substantial room for improvement remains," they conclude.
"Clinical management protocols that can automatically identify patients who require fasting lipid profiles and guide drug therapy management directed at attaining target lipid goals may help improve lipid goal attainment."
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By Joanna Lyford