Lipid Management in Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2013 Clinical Practice Guideline

Perspective:

The following are 10 key points from the Kidney Disease: Developing Global Guidelines (KDIGO) organization on the updated Clinical Practice Guideline for Lipid Management in Chronic Kidney Disease:

1. Knowledge of low-density lipoprotein (LDL) cholesterol is not required to gauge average coronary risk in adults 50 years or older and chronic kidney disease (CKD). The 10-year risk for coronary death or nonfatal myocardial infarction (MI) is consistently >10% in persons who are nondialysis dependent and have estimated glomerular filtration rates (eGFRs) <60 ml/min/1.73 m2.

2. LDL cholesterol is not adequate for the assessment of coronary risk in persons with CKD.

3. In adults ages ≥50 years with eGFR<60 ml/min/1.73 m2, but not treated with chronic dialysis or kidney transplantation, the work group recommends treatment with a statin or statin/ezetimibe combination.

4. In adults ages ≥50 years with CKD and eGFR >60 ml/min/1.73 m2, treatment with a statin is recommended.

5. Initiation of treatment with a statin or statin/ezetimibe combination is not recommended in adults with dialysis-dependent CKD. Statin treatment is recommended in adult kidney transplant recipients.

6. It is reasonable to continue statin therapy in patients who are already receiving such therapy at the time of initiation of dialysis.

7. Adults with newly identified CKD should have evaluation with a lipid profile. Although the work group acknowledges that a lipid profile obtained in the nonfasting state can provide useful information, they recommend that the lipid profile should ideally be measured in the fasting state.

8. However, in adults with CKD (including those treated with chronic dialysis or kidney transplantation), follow-up measurement of lipid levels in not routinely required. Follow-up measurement of lipid levels should be reserved for instances in which the results would modify management.

9. Existing evidence does not support a specific on-treatment LDL cholesterol target. The work group does not recommend statin dose adjustment based on LDL cholesterol level.

10. Fasting triglyceride levels >1000 mg/ml or LDL cholesterol levels >190 mg/dl should prompt consideration of specialist referral for further evaluation.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Lipid Metabolism, Nonstatins, Novel Agents, Statins

Keywords: Risk, Myocardial Infarction, Kidney Transplantation, Follow-Up Studies, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Lipids, Lipoproteins, Cholesterol, Renal Dialysis, Dyslipidemias, Renal Insufficiency, Azetidines, Cardiovascular Diseases, Glomerular Filtration Rate, Triglycerides


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