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Kidney Week

Abstract: FR-PO297

Examining the Characteristics of US Veterans on Triglyceride or HDL Altering Therapy Across Kidney Disease Stage Between 2004-2014

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Soohoo, Melissa, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Hsiung, Jui-Ting, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Park, Christina, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Marroquin, Maria V., Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Moradi, Hamid, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
Background

Current nephrology guidelines do not advocate for pharmacological therapy for triglycerides (TG) or high density lipoprotein (HDL) management in patients with chronic kidney disease (CKD), despite the fact that these lipids may be associated with a higher cardiovascular risk. Nonetheless some patients with CKD receive these medications. We sought to describe the characteristics of US veteran patients receiving fibrate or niacin and whether these characteristics differed by presence of CKD or across CKD stage.

Methods

We identified male veterans with an elevated TG(≥150 mg/dL) or low HDL (<40 mg/dL) who initiated a fibrate or niacin within 90 days of the lipid measurements between 2004-2014. We examined clinical characteristics at the time of fibrate or niacin initiation (N=78,957 and 100,356, respectively), stratified by CKD stage.

Results

In both treatment groups, there was a decreasing trend in fibrate and niacin initiation across higher CKD stage, where a majority of patients were non-CKD, with <1% of patients in stage 5 or end-stage renal disease (ESRD). Veterans with advanced CKD were more likely to be older at the time of fibrate or niacin initiation. In non-CKD and between CKD stage 3A-4, approximately 6-12% of patients on therapy were African-American, however that proportion more than doubled to 20-25% in ESRD/CKD stage 5. Across CKD stages, there was an increase in the proportion of concurrent statin users, with a peak at stage 4 or 5, and then a decline with ESRD. There were similar relationships of comorbidities across CKD stage among fibrate users, where the greatest proportion of cardiovascular conditions was among CKD stage 4 patients.

Conclusion

In US veterans, the proportion of patients with high TG or low HDL prescribed fibrate or niacin decreases with worsening CKD. In future analysis, we will investigate if use of these therapies in CKD patients with elevated TG or low HDL have a lower risk of cardiovascular events.

Funding

  • Veterans Affairs Support