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. 2023 May 25;22(1):67.
doi: 10.1186/s12944-023-01833-z.

International practice patterns of dyslipidemia management in patients with chronic kidney disease under nephrology care: is it time to review guideline recommendations?

Viviane Calice-Silva  1   2 , Daniel Muenz  3 , Michelle M Y Wong  4 , Keith McCullough  3 , David Charytan  5 , Helmut Reichel  6 , Bruce Robinson  3 , Benedicte Stengel  7   8 , Ziad A Massy  7   8   9 , Roberto Pecoits-Filho  10 ; CKDopps Investigators
Collaborators, Affiliations

International practice patterns of dyslipidemia management in patients with chronic kidney disease under nephrology care: is it time to review guideline recommendations?

Viviane Calice-Silva et al. Lipids Health Dis. .

Abstract

Background: In contrast to guidelines related to lipid therapy in other areas, 2012 Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend conducting a lipid profile upon diagnosis of chronic kidney disease (CKD) and treating all patients older than 50 years without defining a target for lipid levels. We evaluated multinational practice patterns for lipid management in patients with advanced CKD under nephrology care.

Methods: We analyzed lipid-lowering therapy (LLT), LDL- cholesterol (LDL-C) levels, and nephrologist-specified LDL-C goal upper limits in adult patients with eGFR < 60 ml/min from nephrology clinics in Brazil, France, Germany, and the United States (2014-2019). Models were adjusted for CKD stage, country, cardiovascular risk indicators, sex, and age.

Results: LLT treatment differed significantly by country, from 51% in Germany to 61% in the US and France (p = 0.002) for statin monotherapy. For ezetimibe with or without statins, the prevalence was 0.3% in Brazil to 9% in France (< 0.001). Compared with patients not taking lipid-lowering therapy, LDL-C was lower among treated patients (p < 0.0001) and differed significantly by country (p < 0.0001). At the patient level, the LDL-C levels and statin prescription did not vary significantly by CKD stage (p = 0.09 LDL-C and p = 0.24 statin use). Between 7-23% of untreated patients in each country had LDL-C ≥ 160 mg/dL. Only 7-17% of nephrologists believed that LDL-C should be < 70 mg/dL.

Conclusion: There is substantial variation in practice patterns regarding LLT across countries but not across CKD stages. Treated patients appear to benefit from LDL-C lowering, yet a significant proportion of hyperlipidemia patients under nephrologist care are not receiving treatment.

Keywords: Chronic kidney disease; Dyslipidemia; LDL-C; Lipids management; Statins.

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Conflict of interest statement

This manuscript was directly supported by Amgen. Global support for the ongoing DOPPS Programs is provided without restriction on publications by a variety of funders. For details see https://www.dopps.org/AboutUs/Support.aspx.

Figures

Fig. 1
Fig. 1
Prevalence and intensity of statin use by country and A CKD stage or B cardiovascular risk. Atorvastatin and rosuvastatin are categorized as high intensity; all other statins are categorized as low intensity: simvastatin, lovastatin, pravastatin, fluvastatin, cerivastatin, and pitavastatin. The composite cardiovascular (CV) risk is based on comorbidity burden (any history of coronary disease, diabetes, or ischemic stroke) and age
Fig. 2
Fig. 2
LDL-C (fasting) goal upper limit by country and CKD stage, according to clinic nephrologists. Nephrologists were allowed to respond “No upper limit”; the numbers of nephrologists so responding were 1 (Brazil), 6 (France), 1 (Germany), and 8 (the US)
Fig. 3
Fig. 3
Distribution of LDL-C (mg/dL) by country and statin use and intensity. Statin use was ascertained within 6 months before the LDL-C measurement. To determine statin intensity, patients with no statin use in that time window were categorized as “none”; patients using atorvastatin or rosuvastatin ever within the window were categorized as “high”; and patients using any other statin were categorized as “low”
Fig. 4
Fig. 4
Mean LDL-C levels by eGFR and by country. Representation of Mean LDL-C patients levels considering eGFR and stratified by country
See this image and copyright information in PMC

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