Use of Statins for Primary Prevention Among Individuals With CKD in the United States: A Cross-Sectional, Time-Trend Analysis

Abstract

Rationale & objective: Chronic kidney disease (CKD) populations face an elevated risk of cardiovascular disease (CVD), yet many remain undertreated with statins for primary prevention of CVD despite meeting eligibility criteria. We examined trends in statin use for primary prevention among individuals with CKD before and after the release of the 2013 Kidney Disease: Improving Global Outcomes (KDIGO) guideline recommending statin use for lipid management in selected adults with CKD.

Study design: Cross-sectional time-trend analysis.

Setting & participants: The 2001-2020 National Health and Nutrition Examination Survey (NHANES) data permitted identification of individuals eligible for statin therapy per the 2013 KDIGO guidelines based on (1) age≥50 without self-reported CVD; (2) CKD, defined as estimated glomerular filtration rate (eGFR)<60mL/min/1.73m² or albumin-creatinine ratio≥30mg/g; and (3) no dialysis in the previous 12 months.

Outcome: Statin use.

Analytical approach: Poisson regression to estimate prevalence ratios (PR) comparing the periods before and after KDIGO guideline release and after accounting for NHANES's complex survey design and sampling weights.

Results: Among eligible individuals, statin use approximately doubled from 18.6% in 2001-2002 to 36.1% in 2007-2008, increased modestly to 40.1% in 2013-2014, then subsequently plateaued. Multivariable analyses controlling for sociodemographic and clinical characteristics and secular trends demonstrated statin use for primary prevention was higher among the insured (PR, 2.48 [95% CI 1.66-3.69]), those with hypertension (PR, 1.49 [95% CI 1.28-1.74]), and those with diabetes (PR, 1.71 [95% CI 1.52-1.92]). Statin use was more common with lower eGFR (P=0.009) and higher body mass index (P=0.003) but did not differ by sex, race, or ethnicity.

Limitations: Statin use and CVD were self-reported, and our data did not capture statin intolerance nor patient-provider decision making information.

Conclusions: Statin use for primary prevention in CKD substantially increased before the 2013 release of KDIGO guidelines and subsequently plateaued. Use was higher among the insured and those with hypertension or diabetes.

Plain-language summary: Chronic kidney disease (CKD) affects many Americans, increasing their heart disease risk. Statins effectively reduce this risk in individuals with CKD but are underused. Our study examined statin use in individuals with CKD before and after the release of the 2013 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommending statin use for selected adults with CKD. It also examined factors influencing usage patterns. Using years of US National Health and Nutrition Examination Survey data, we found that while statin use doubled over the study period, fewer than half of eligible individuals with CKD received statins for primary prevention. Statin use was more common among those with health insurance, high blood pressure, or diabetes. This underuse highlights potential opportunities for improved risk monitoring and preventive use of statin therapy for individuals with CKD.

Keywords: CKD; CVD; Cardiovascular disease; NHANES; chronic kidney disease; primary prevention; statin use.