Abstract: SA-PO883
Patterns of Care for Lipid Management in CKD Stage 3-5 Patients: Results from CKDopps
Session Information
- CKD: Pharmacoepidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Muenz, Daniel G., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Reading, Stephanie R., Amgen, Los Angeles, California, United States
- McCullough, Keith, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Calice-Silva, Viviane, Pro-Kidney Foundation, Joinville, Brazil
- Dluzniewski, Paul, Amgen, Los Angeles, California, United States
- Massy, Ziad, Ambroise Pare University Hospital and Inserm U1018 Eq5, Boulogne Billancourt/ Paris cedex, France
- Philip, Kiran, Amgen, Los Angeles, California, United States
- Reichel, Helmut, Nephrological Center Villingen-Schwenningen, Villingen-Schwenningen, Germany
- Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background
Current KDIGO guidelines recommend conducting a lipid profile upon diagnosis for chronic kidney disease (CKD) and treating patients >50 years with a statin +/- ezetimibe. However, these guidelines do not provide target lipid levels for treatment. Thus, we aimed to evaluate current nephrologist care practice patterns for lipid management, including perceptions of target levels of LDL-cholesterol (LDL-C), statin/ezetimibe prescription, and achieved LDL-C using the CKD Outcomes and Practice Patterns Study (CKDopps).
Methods
We analyzed patient-level treatment and LDL-C levels and nephrologist-specified target LDL-C upper limits from CKDopps clinics in Brazil, Germany, and the United States (2013-2018). Patients were ≥18 years old with eGFR <60ml/min at enrollment. P-values were obtained from a logistic model of the prevalence of treatment with statins +/- ezetimibe by age (< or ≥50), country, and CKD stage; and a linear model of mean LDL-C by treatment, country, and CKD stage. Both models used generalized estimating equations to account for patient clustering by clinic.
Results
Statin/ezetimibe treatment was more prevalent among CKD patients ≥50 years-old (p<0.0001) and differed significantly by country (p=0.001; Figure 1a). LDL-C was lower among treated patients (p<0.0001) and differed significantly by country (p<0.0001; Figure 1b). Neither patient-level outcome varied significantly by CKD stage (p≥0.2). 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 lipid-lowering therapies across countries, but not across CKD stages. Treated patients appear to benefit with regard to LDL-C lowering, yet a significant proportion of hyperlipidemia patients are not receiving treatment.
Funding
- NIDDK Support – This analysis was supported by Amgen. The DOPPS Program is supported by Amgen (since 1996, founding sponsor), Kyowa Hakko Kirin (since 1999 for Japan DOPPS), and Baxter Healthcare Corp. Additional support for specific projects and countries is provided by Akebia Therapeutics, AstraZeneca, European Renal Association-European Dialysis & Transplant Association (ERA-EDTA), Fibrogen, Fresenius Medical Care Asia-Pacific Ltd, Fresenius Medical Care Canada Ltd, German Society of Nephrology (DGfN), Italian Society of Nephrology (SIN), Janssen, Japanese Society for Peritoneal Dialysis (JSPD), Kidney Care UK, MEDICE Arzneimittel Pütter GmbH & Co KG, Otsuka America, Proteon Therapeutics, the Association of German Nephrology Centres, and Vifor Fresenius Medical Care Renal Pharma. Public funding and support is provided for specific DOPPS projects, ancillary studies, or affiliated research projects by National Health & Medical Research Council (NHMRC) in Australia, Belgian Federal Public Service of Public Health in Belgium, Cancer Care Ontario (CCO) through the Ontario Renal Network (ORN) in Canada, French National Institute of Health and Medical Research (INSERM) in France, Thailand Research Foundation (TRF), Chulalongkorn University Matching Fund, King Chulalongkorn Memorial Hospital Matching Fund, and the National Research Council of Thailand (NRCT) in Thailand, National Institute for Health Research (NIHR) via the Comprehensive Clinical Research Network (CCRN), and Kidney Research UK (KRUK) in the United Kingdom, and the Agency for Healthcare Research and Quality (AHRQ) and National Institutes of Health (NIH) in the US. All support is provided without restrictions on publications. All grants are made to Arbor Research Collaborative for Health and not to Dr. Muenz directly.