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Comparative Study
. 2015 May;26(5):1173-80.
doi: 10.1681/ASN.2014040400. Epub 2014 Nov 13.

Contrasting Cholesterol Management Guidelines for Adults with CKD

Lisandro D Colantonio  1 , Usman Baber  2 , Maciej Banach  3 , Rikki M Tanner  1 , David G Warnock  4 , Orlando M Gutiérrez  5 , Monika M Safford  4 , Christoph Wanner  6 , George Howard  7 , Paul Muntner  8
Affiliations
Comparative Study

Contrasting Cholesterol Management Guidelines for Adults with CKD

Lisandro D Colantonio et al. J Am Soc Nephrol. 2015 May.

Abstract

The Kidney Disease Improving Global Outcomes Lipid Work Group recommends statins for adults ≥50 years old with CKD. The American College of Cardiology/American Heart Association endorses statins for adults with atherosclerotic cardiovascular disease, adults with LDL cholesterol≥190 mg/dl, and adults 40-79 years old with LDL cholesterol=70-189 mg/dl and diabetes or a 10-year predicted risk for atherosclerotic cardiovascular disease ≥7.5% estimated using the Pooled Cohort risk equations. Using data from the Reasons for Geographic and Racial Differences in Stroke Study, we calculated the agreement for statin treatment between these two guidelines for adults 50-79 years old with CKD (eGFR<60 ml/min per 1.73 m(2) or albuminuria≥30 mg/g) not on dialysis. We assessed the validity of the Pooled Cohort risk equations in individuals with CKD. Study participants were enrolled between 2003 and 2007, and we report incident cardiovascular disease events (stroke and coronary heart disease) through December of 2010. Among 4726 participants with CKD, 2366 (50%) were taking statins, and 1984 (42%) were recommended statins by the American College of Cardiology/American Heart Association guideline but not taking them. Overall, 376 (8%) participants did not meet the American College of Cardiology/American Heart Association criteria for initiating statin treatment. Cardiovascular disease incidence was low (3.0/1000 person-years; 95% confidence interval, 0.1 to 5.9) among these participants. The Pooled Cohort risk equations were well calibrated (Hosmer-Lemeshow chi-squared=2.7, P=0.45) with moderately good discrimination (C index, 0.71; 95% confidence interval, 0.65 to 0.77). In conclusion, these guidelines show high concordance for statin treatment for adults with CKD.

Keywords: cardiovascular disease; cholesterol; chronic kidney; disease; practice guidelines; statins.

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Figures

Figure 1.
Figure 1.
Consideration of statin initiation is recommended by the 2013 ACC/AHA cholesterol treatment guideline for a high proportion of REGARDS Study participants with CKD. †Or non–HDL-C=100–219 mg/dl.
Figure 2.
Figure 2.
The ASCVD Pooled Cohort risk equations show good calibration among study participants with CKD, eGFR<60 ml/min per 1.73 m2 and ACR≥30 mg/g. Good calibration is determined by similar observed and predicted rates.
Figure 3.
Figure 3.
The incidence of ASCVD is low among REGARDS Study participants with CKD and a 10-year predicted ASCVD risk <7.5%. The dotted line represents the 10-year ASCVD predicted risk considered by the ACC/AHA Task Force as the threshold for initiation of statins.
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