Abstract: TH-PO554

Low Utilization of Statins in US Veterans with Non-Dialysis Dependent CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 307 CKD: Health Services, Disparities, Prevention

Authors

  • Leehey, David J., Hines VA Medical Center, Hines, Illinois, United States
  • Markossian, Talar, Loyola University Chicago, Maywood, Illinois, United States
  • Burge, Nicholas, Hines VA Medical Center, Hines, Illinois, United States
  • Stroupe, Kevin, Hines VA Medical Center, Hines, Illinois, United States
  • Pacold, Ivan, Hines VA Medical Center, Hines, Illinois, United States
  • Schneider, Julia, Hines VA Medical Center, Hines, Illinois, United States
  • Ling, Benjamin, Hines VA Medical Center, Hines, Illinois, United States
  • Kramer, Holly J., Loyola University Medical Center, Maywood, Illinois, United States
Background

Cardiovascular disease is the major cause of morbidity and mortality among adults with non-dialysis dependent chronic kidney disease (CKD). Statin medications, especially when combined with ezetimibe, significantly reduce atherosclerotic cardiovascular disease (ASCVD) risk in this population. Renal guidelines therefore recommend statin use for all patients with non-dialysis dependent CKD age 50 years or older regardless of lipid profile. However, the recent AHA/ACC recommendations for statin use for adults (including those with CKD) in the absence of ASCVD or diabetes is based on the predicted 10-year ASCVD risk derived from the pooled risk cohort equation. The objective of this study was to examine statin utilization in a national sample of U.S. Veterans with non-dialysis dependent CKD, defined as an eGFR < 60 ml/min/1.73 m2, and to calculate the predicted ASCVD risk by diabetes status using the pooled risk cohort equation.

Methods

The design was a retrospective review of statin use and clinical and demographic factors associated with statin use. Statin use was ascertained from pharmacy dispensing records during fiscal years 2012 and 2013. The study included 581,344 Veterans age ≥ 50 years with non-dialysis dependent CKD stages 3-5 with no history of kidney transplantation or dialysis receiving care at VA healthcare facilities.

Results

97% of patients were male and 58% were older than 70 years. Statin use ranged from as high as 76% in those with ASCVD or diabetes to as low as 22% in those without these conditions (p<0.001). Overall, 94% of Veterans without diabetes and 97% of Veterans with diabetes had a ASCVD risk score >7.5%, of whom 42% were not using statins. Strikingly, even in patients in whom the ASCVD risk score was very high (>= 20%), only 52% of non-diabetic CKD patients and 75% of diabetic patients were using statins.

Conclusion

Utilization of statins is low in Veterans with non-dialysis dependent CKD in the absence of well-known indications for statin use (i.e., ASCVD or diabetes) despite high-predicted ASCVD risk. We conclude that whether one follows renal or cardiovascular guidelines, statin utlization is suboptimal in CKD patients. National education efforts will be needed to increase statin use in CKD, especially in patients without established ASCVD or diabetes.