Statins for CKD

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New guidelines from the Kidney Disease: Improving Global Outcomes (KDIGO) workgroup recommend wider statin use among patients with chronic kidney disease.

A synopsis of 8 key recommendations regarding lipid management and monitoring in adults with CKD, including those receiving chronic dialysis or who have had kidney transplants was published online December 9 in the Annals of Internal Medicine.

A key recommendation was for treatment with statin or statin with ezetimibe of adults at least 50 years of age who have an estimated glomerular filtration rate (eGFR) less than 60 mL/minute per 1.73 m2 and who are not treated with chronic dialysis or kidney transplantation. This was a 1A level recommendation, based on the Study of Heart and Renal Protection (SHARP; Lancet. 2011;377:2181–2192).
Adults with dialysis–dependent CKD should not begin treatment with statins or statin/ezetimibe. (2A)
Patients already taking a statin at the time of dialysis should continue to do so. (2C)
Kidney transplant patients should receive statin treatment because their risk for coronary events is dramatically increased. (2B)
Adults aged 18 to 49 years who have an eGFR less than 60 mL/minute per 1.73 m2 but who are not treated with dialysis or kidney transplantation should be treated with statins if they are known to have coronary disease, diabetes, prior ischemic stroke, or an estimated 10–year incidence of coronary death or nonfatal myocardial infarction exceeding 10%. (2A)
Among persons with CKD, low–density lipoprotein cholesterol is an insufficient test for cardiovascular risk. Adults with newly diagnosed CKD should therefore undergo lipid profile testing. (1C)
However, follow–up measurement is not needed. (Not graded)
Adults aged 50 years or older who have CKD and an eGFR 60 mL/minute per 1.73 m2 or higher (GFR categories G1 – G2) should be treated with a statin. (1B)