Abstract: FR-PO1107
Evaluation of LDL-Cholesterol Target Attainment in CKD: A Real-World Audit Against European Society of Cardiology Guidelines
Session Information
- Health Maintenance, Nutrition, and Metabolism
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance, Nutrition, and Metabolism
- 1500 Health Maintenance, Nutrition, and Metabolism
Author
- O'Connell, Blathnaid, Galway University Hospitals, Galway, County Galway, Ireland
Background
Cardiovascular disease is the leading cause of mortality in chronic kidney disease (CKD). The European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) classify CKD as a condition with high or very high cardiovascular risk, increasing with CKD stage. An LDL cholesterol (LDL-C) target of ≤1.4mmol/L is recommended for those with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m2 and ≤1.8mmol/L for those with eGFR 30–59 mL/min/1.73m2. This audit evaluates LDL-C target attainment and the frequency of lipid-lowering therapy (LLTx) prescribing in a single-centre CKD cohort.
Methods
Medication and laboratory records for all patients with an eGFR <60mL/min/1.73m2, but not on dialysis, and kidney transplants who attended a single-centre nephrology outpatient clinic between December 2023 and December 2024 were retrospectively reviewed. Individuals were categorised by eGFR (stage 3 = eGFR 30–59mL/min/1.73m2; stage 4/5 = eGFR 1-29mL/min/1.73m2) and transplant status. LDL-C levels, LLTx use, and adherence to ESC targets were determined.
Results
Of 608 individuals in the cohort, 47 were excluded (10 had hypertriglyceridaemia rendering LDL-C incalculable, 37 did not have lipids measured). Among non-transplant stage 4/5 CKD (n=299), only 29% (n=86) met the LDL-C target (≤1.4mmol/L) with 71% (n=213) off-target, with a mean LDL-C excess of 0.99mmol/L. Notably, 37% of those not at target (n=79) were not on any LLTx. Of those on maximum dose statin (n=25), 56% (n=14) remained off target. Among CKD stage 3 (n=180), only 11% (n=19) met the LDL-C target (<1.8mmol/L) with 89% (n=161) off-target, with a mean LDL-C excess of 2.39mmol/L. In the kidney transplant cohort, LDL-C target attainment was higher in those with stage 4 and 5 CKD (5/13; 38%) but remained suboptimal in those with stage 3 CKD (19/71; 27%). A substantial proportion of transplant recipients (42%) were not on any LLTx.
Conclusion
LDL-C target attainment in our CKD and transplant cohort is suboptimal and not adherent to ESC recommendations. The majority of patients are untreated or inadequately treated, particularly those with stage 3 CKD. These findings underscore the need for enhanced lipid management strategies, including early intervention, combination therapy & multidisciplinary collaboration to improve cardiovascular outcomes in this high-risk population.