Practice Guideline

. 2024 Aug;29(8):495-509.

doi: 10.1111/nep.14295. Epub 2024 Apr 29.

Australian and New Zealand Living Guideline cholesterol-lowering therapy for people with chronic kidney disease (CARI Guidelines): Reducing the evidence-practice gap

Brydee Cashmore^{1

2}, David J Tunnicliffe^{1

2}, Suetonia Palmer³, Llyod Blythen⁴, Jane Boag^{4

5}, Karam Kostner⁶, Rathika Krishnasamy^{7

8

9}, Kelly Lambert¹⁰, Andrea Miller¹¹, Judy Mullan¹⁰, Maira Patu¹², Richard K S Phoon^{13

14}, Liz Rix¹⁵, Natasha Trompf⁴, David W Johnson^{9

16

17}, Robert Walker¹⁸; CARI Guidelines Steering Committee

Collaborators, Affiliations

Collaborators

CARI Guidelines Steering Committee:
Rathika Krishnasamy, Vincent Lee, Jane Boag, Helen Coolican, Vanessa Cullen, Debbie Fortnum, Hicham Hassan, Min Jun, Jonathan Craig, Kelly Lambert, Casey Light, Thu Nguyen, Suetonia Palmer, Carla Scuderi, Emily See, Andrea Viecelli, Rachael Walker

Affiliations

¹ Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
² Centre for Kidney Research, The Children's Hospital of Westmead, Sydney, New South Wales, Australia.
³ Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.
⁴ Consumer Partner, Australia.
⁵ School of Health, Federation University, Ballarat, Victoria, Australia.
⁶ Mater Hospital, University of Queensland, St Lucia, Queensland, Australia.
⁷ Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
⁸ Centre for Kidney Disease Research, The University of Queensland, Brisbane, Queensland, Australia.
⁹ Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.
¹⁰ Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.
¹¹ Cape York Kidney Care, Weipa Integrated Health Services, Weipa, Queensland, Australia.
¹² Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand.
¹³ Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
¹⁴ Department of Renal Medicine, Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia.
¹⁵ Adelaide Nursing School, University of Adelaide, Adelaide, South Australia, Australia.
¹⁶ Department of Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
¹⁷ Translational Research Institute, Brisbane, Queensland, Australia.
¹⁸ Department of Medicine, University of Otago Dunedin, Dunedin, New Zealand.

PMID: 38684481
DOI: 10.1111/nep.14295

Practice Guideline

Australian and New Zealand Living Guideline cholesterol-lowering therapy for people with chronic kidney disease (CARI Guidelines): Reducing the evidence-practice gap

Brydee Cashmore et al. Nephrology (Carlton). 2024 Aug.

. 2024 Aug;29(8):495-509.

doi: 10.1111/nep.14295. Epub 2024 Apr 29.

Authors

Collaborators

CARI Guidelines Steering Committee:
Rathika Krishnasamy, Vincent Lee, Jane Boag, Helen Coolican, Vanessa Cullen, Debbie Fortnum, Hicham Hassan, Min Jun, Jonathan Craig, Kelly Lambert, Casey Light, Thu Nguyen, Suetonia Palmer, Carla Scuderi, Emily See, Andrea Viecelli, Rachael Walker

Affiliations

¹ Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
² Centre for Kidney Research, The Children's Hospital of Westmead, Sydney, New South Wales, Australia.
³ Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.
⁴ Consumer Partner, Australia.
⁵ School of Health, Federation University, Ballarat, Victoria, Australia.
⁶ Mater Hospital, University of Queensland, St Lucia, Queensland, Australia.
⁷ Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
⁸ Centre for Kidney Disease Research, The University of Queensland, Brisbane, Queensland, Australia.
⁹ Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.
¹⁰ Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.
¹¹ Cape York Kidney Care, Weipa Integrated Health Services, Weipa, Queensland, Australia.
¹² Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand.
¹³ Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
¹⁴ Department of Renal Medicine, Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia.
¹⁵ Adelaide Nursing School, University of Adelaide, Adelaide, South Australia, Australia.
¹⁶ Department of Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
¹⁷ Translational Research Institute, Brisbane, Queensland, Australia.
¹⁸ Department of Medicine, University of Otago Dunedin, Dunedin, New Zealand.

PMID: 38684481
DOI: 10.1111/nep.14295

Abstract

Aim: People with chronic kidney disease experience high rates of cardiovascular disease. Cholesterol-lowering therapy is a mainstay in the management but there is uncertainty in the treatment effects on patient-important outcomes, such as fatigue and rhabdomyolysis. Here, we summarise the updated CARI Australian and New Zealand Living Guidelines on cholesterol-lowering therapy in chronic kidney disease.

Methods: We updated a Cochrane review and monitored newly published studies weekly to inform guideline development according to international standards. The Working Group included expertise from nephrology, cardiology, Indigenous Health, guideline development and people with lived experience of chronic kidney disease.

Results: The guideline recommends people with chronic kidney disease (eGFR ≥15 mL/min/1.73 m²) and an absolute cardiovascular risk of 10% or higher should receive statin therapy (with or without ezetimibe) to reduce the risk of cardiovascular events and death (strong recommendation, moderate certainty evidence). The guidelines also recommends a lower absolute cardiovascular risk threshold (≥5%) for Aboriginal and Torres Strait Islander Peoples and Māori with chronic kidney disease to receive statin therapy (with or without ezetimibe) (strong recommendation, low certainty evidence). The evidence was actively surveyed from 2020-2023 and updated as required. No changes to guideline recommendations were made, with no new data on the balance and benefits of harms.

Conclusions: The development of living guidelines was feasible and provided the opportunity to update recommendations to improve clinical decision-making in real-time. Living guidelines provide the opportunity to transform chronic kidney disease guidelines.

Keywords: cholesterol lowering therapy; chronic kidney disease; clinical practice guideline.

PubMed Disclaimer

References

REFERENCES

1. Johnson DW, Atai E, Chan M, et al. KHA‐CARI guideline: early chronic kidney disease: detection, prevention and management. Nephrology (Carlton). 2013;18(5):340‐350.
1. Cheyne S, Fraile Navarro D, Hill K, et al. Methods for living guidelines: early guidance based on practical experience. J Clin Epidemiol. 2023;155:84‐96.
1. El Mikati IK, Khabsa J, Harb T, et al. A framework for the development of living practice guidelines in health care. Ann Intern Med. 2022;175(8):1154‐1160.
1. Tunnicliffe DJ, Palmer SC, Cashmore BA, et al. HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis. Cochrane Database Syst Rev. 2023;11(11):Cd007784.
1. Andrews JC, Schünemann HJ, Oxman AD, et al. GRADE guidelines: 15. Going from evidence to recommendation 2014; determinants of a recommendation's direction and strength. J Clin Epidemiol. 2013;66(7):726‐735.

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Australian and New Zealand Living Guideline cholesterol-lowering therapy for people with chronic kidney disease (CARI Guidelines): Reducing the evidence-practice gap

Collaborators

Affiliations

Australian and New Zealand Living Guideline cholesterol-lowering therapy for people with chronic kidney disease (CARI Guidelines): Reducing the evidence-practice gap

Authors

Collaborators

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous