Statins underutilized in adults with CKD

  • Mefford MT & al.
  • J Am Heart Assoc
  • 22 Jan 2019

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Statins are underutilized among patients with chronic kidney disease (CKD) in the U.S, according to an analysis of data from the National Health and Nutrition Examination Surveys (NHANES).

Why this matters

  • 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines did not include CKD as a statin-benefit group.
  • 2018 guidelines recommend statins for adults with nondialysis CKD with low-density lipoprotein levels ≥70 mg/dL and a 10-year atherosclerotic cardiovascular disease risk ≥7.5%.

Study design

  • Analysis of NHANES data from 1999-2002 through 2011-2014, for 38,336 adults aged ≥20 years; 7153 (18.7%) had CKD, defined by estimated glomerular filtration rate 2 or albumin-to-creatinine ratio ≥30 mg/g.
  • Funding: Amgen, University of Alabama at Birmingham, Icahn School of Medicine at Mount Sinai. 

Key results

  • From 1999-2002 to 2011-2014, the proportion of statin-treated adults increased:
    • CKD: from 17.6% to 35.7%.
    • Non-CKD: from 6.8% to 14.7%.
  • In 2011-2014, the proportion of individuals with a statin indication (2013 guidelines):
    • CKD: 65.3%.
    • Non-CKD: 27.4%.
  • In multivariate analysis, CKD did not predict statin use (prevalence ratio [PR]=1.01; 95% CI, 0.96-1.08).
  • Statin use was lower among patients with CKD-only vs diabetes-only (PR=0.54; 95% CI, 0.44-0.66).

Limitations

  • Survey data.
  • Lag to new guideline implementation.

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