Kidney Patients Who Need Statins Might Not Take Them

Most chronic kidney disease patients needed to take statins to follow current guidelines, but many did not

(RxWiki News) Two major health groups recommend statins for many patients with chronic kidney disease. But a new study found that many patients who should take statins didn't take them — even after a doctor recommended that they do so.

The authors of the new study found that, according to existing guidelines, nearly all patients with chronic kidney disease should take statins. They also found that half of patients whose doctors recommended statins didn't take the cholesterol-lowering medications.

The authors recommended that doctors use the existing guidelines as tools to educate their patients about statin use.

Kidney disease and heart disease often go hand-in-hand, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Chronic kidney disease can increase the risk of heart disease. Maintaining normal cholesterol levels is important for patients who are at risk for heart disease.

Statins are medications that can lower high cholesterol. Lowered cholesterol may decrease the risk of death from heart attack.

Lisandro D. Colantonio, MD, of the University of Alabama at Birmingham School of Public Health, led the research team.

The American College of Cardiology (ACC), with the American Heart Association (AHA), and the Kidney Disease Improving Global Outcomes Lipid Work Group (KDIGO) released cholesterol management guidelines in 2013. The two sets of guidelines are slightly different. Each guideline, however, recommends statins for people with chronic kidney disease or a high risk for heart disease and stroke.

The ACC/AHA guidelines recommend statins in patients who have a history of heart problems, diabetes or very high cholesterol. They also use a special formula to identify patients who should take statins.

The KDIGO Lipid Work Group recommends in its guidelines that patients who have chronic kidney disease and who are between 50 and 79 years old should take statins.

Because the recommendations from the two groups are different, the Dr. Colantonio and colleagues compared them using data from a past study called REGARD. REGARD stands for REasons for Geographic and Racial Differences in Stroke. The REGARD study included more than 30,000 US adults. The authors of the current study looked at the patients from this group who were between 50 and 79 years old and had chronic kidney disease — 4,726 patients.

Dr. Colantonio and team found that, based on the ACC/AHA guidelines, 92 percent of those patients needed to take statins. According to the KDIGO guidelines, all of the patients should have been taking statins.

The researchers also found that, even when doctors recommended statins, around 50 percent of the patients did not take them. Statins include atorvastatin (brand name Lipitor), fluvastatin (Lescol), lovastatin (Mevacor, Altocor), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor). Patients should only take medication under the direction of a doctor.

“These results indicate that either guideline can be used to inform the decision to initiate statin therapy for people with [chronic kidney disease] who are 50 to 79 years of age,” Dr. Colantonio said in a press release. “They also show that there is an unmet treatment need and a missed opportunity for lowering heart disease risk among patients with [chronic kidney disease].”

The current study was published Nov. 13 in the Journal of the American Society of Nephrology.

This study was funded by the National Institute of Neurological Disorders and Stroke, National Institutes of Health, and Department of Health and Human Service Cooperative Agreement. Grants from the National Heart, Lung and Blood Institute and Amgen Inc. also funded the research.

The authors disclosed that Drs. David G. Warnock, Monika M. Safford and Paul Muntner received grant support from Amgen Inc.

Review Date: 
November 12, 2014