International practice patterns of dyslipidemia management in patients with chronic kidney disease under nephrology care: is it time to review guideline recommendations?
Viviane Cálice-Silva, Daniel G. Muenz, Michelle Wong, Keith McCullough, David M. Charytan, Helmut Reichel, Bruce Robinson, Bénédicte Stengel, Ziad A. Massy, Roberto Pecoits‐Filho, on behalf of CKDopps Investigators, Antonio Lopes, Christian Combe, Christian Jacquelinet, Ziad A. Massy, Johannes Duttlinger, Danilo Fliser, Gerhard Lonnemann, Takashi Wada, Kunihiro Yamagata, R. Pisoni, Viviane Calice-Silva, Ricardo Sesso, Élodie Speyer, Natália Alencar de Pinho, Koichi Asahi, Junichi Hoshino, Ichiei Narita, Rachel Perlman, Friedrich K. Port, Nidhi Sukul, Michelle Wong, Eric W. Young, Jarcy Zee
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.