Concepts and Controversies: Lipid Management in Patients with Chronic Kidney Disease

Mathew, Roy; Rosenson, Robert S.; Lyubarova, Radmila; Chaudhry, Rafia; Costa, Salvatore P.; Bangalore, Sripal; Sidhu, Mandeep S.

doi:10.1007/s10557-020-07020-x

Cited by 16 publications

(14 citation statements)

References 74 publications

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“…The roles of lipid profiles on CKD progression have not been well-established. Similar to the conclusion from a recent review, we did not find a consistent relationship between cholesterol on risks of transition in different CKD states ( 34 ). In this study, HDL plays a more significant role in early CKD state transition, whereas higher LDL levels were associated with a more transition risk to the advanced CKD stage.…”

Section: Discussionsupporting

confidence: 89%

Factors associated with renal function state transitions: A population-based community survey in Taiwan

Tsai

Lin

Hsu

et al. 2022

Front. Public Health

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BackgroundUnderstanding renal function state transition risk and associated factors in community residences is vital for appropriate preventive and care actions. We aim to investigate factors affecting renal function state transitions through 10-year longitudinal community screening surveys.MethodsThe prospective cohort study included participants who attended the screening program ≥2 times from 2001 to 2009 and were divided into two cohorts: those with baseline estimated glomerular filtration rate (eGFR) ≥60 (n = 46,278) and those with eGFR 59–30 mL/min/1.73 m2 (n = 4,656). We applied the illness-death model to identify associated factors with eGFR <60 and death for the cohort with baseline eGFR ≥60 and eGFR <30 and death for that with baseline eGFR ≥59–30.ResultsAmong the followed-up participants, 3,018 (6.5%) in the cohort of baseline eGFR ≥60 mL/min/1.73 m2 and 322 (6.9%) in the cohort of eGFR 59–30 mL/min/1.73 m2 experienced renal function state transition during a median over 7-year follow-up. Besides eGFR and grade of proteinuria, diabetes mellitus (adding nearly 50% hazard rate) is the main factor associated with both state transitions. Other early-phase eGFR state transition risk factors were metabolic syndrome score, triglyceride, uric acid, fasting blood sugar, and high-density lipoprotein cholesterol. Males, poor hemoglobin, high triglyceride, and high low-density lipoprotein cholesterol were all linked with the late-phase eGFR state transition hazard rate.ConclusionThe study developed the state transition functions for community participants with varying renal function levels. Further actions to develop precision screening plans and services that incorporate personal risk factors and state transition risks are necessary.

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Section: Discussionsupporting

confidence: 89%

Factors associated with renal function state transitions: A population-based community survey in Taiwan

Tsai

Lin

Hsu

et al. 2022

Front. Public Health

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“…Serum lipid levels are among the major components of the cardiovascular risk profile. It is accepted that dyslipidemia also contributes to CKD progression 33 . Important components of dyslipidemia in the CKD course include high serum triglyceride levels, low serum HDL levels, and HDL dysfunction even if its level is normal 34,35 .…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Serum Magnesium Level, Plasma Atherogenic Index and Glomerular Filtration Rate

Bayrakci¹,

EVEN²,

KARABACAK³

et al. 2022

NKTD

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Amaç: Magnezyum, kardiyovasküler hastalıklar başta olmak üzere birçok kronik hastalıkla ilişkilendirilmektedir. Bu çalışmanın amacı, serum magnezyum düzeyi, plazma aterojenik indeksi (PAİ) ve glomerüler filtrasyon hızı (GFH) arasındaki ilişkinin değerlendirilmesidir.Gereç ve Yöntem: Çalışmaya dahil edilen 214 hastanın verileri retrospektif olarak incelendi. Tahmini GFH 60 mL/dakika/1,73 m 2 ve üzerinde olanlar "yüksek GFH grubu", 60 mL/dakika/1,73 m 2 'den düşük olanlar "düşük GFH grubu" olarak gruplandırıldı. Serum trigliserit düzeyinin serum yüksek yoğunluklu lipoprotein düzeyine oranının logaritması alınarak PAİ hesaplandı.Bulgular: yüksek GFH grubunda 72, düşük GFH grubunda 142 hasta yer aldı. Serum magnezyum düzeyi ve PAİ açısından gruplar arasında farklılık saptanmadı. Tüm popülasyonda serum magnezyum düzeyi ile ilişkili faktörler incelendiğinde, sadece PAİ ile magnezyum arasında negatif yönde bir ilişki saptandı [Odds ratio (OR): -0,212]. Yine tüm popülasyonda PAİ ile ilişkili faktörler incelendiğinde, PAİ ile serum magnezyum düzeyi arasında negatif (OR: -0,189); vücut kitle indeksi, sistolik kan basıncı ve serum ürik asit düzeyi arasında pozitif yönde bir ilişki saptandı (sırasıyla; OR: 0,154; 0,276; 0,165). Gerek PAİ, gerekse magnezyum düzeyleri ile tahmini glomerüler filtrasyon hızı arasında ilişki saptanmadı.

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“…The 2018 American Heart Association (AHA)/American College of Cardiology (ACC)/Multispecialty cholesterol guidelines recommend a high‐intensity statin with ezetimibe and/or PCSK9i for high‐risk ASCVD patients with CKD and LDL‐C levels

\ge

70 mg/dL 12 . While evidence for LDL‐C lowering in the prevention of ASCVD in CKD patients primarily derives from post hoc analyses, subgroup analyses of multiple clinical trials support benefit 13 . A meta‐analysis of 13 studies showed that statins reduced the risk of major cardiovascular events in Stage 3 CKD (pooled hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.67–‐0.78) and stage 4 CKD (pooled HR 0.78, 95% CI 0.40–0.96) patients.…”

Section: Introductionmentioning

confidence: 99%

“… 12 While evidence for LDL‐C lowering in the prevention of ASCVD in CKD patients primarily derives from post hoc analyses, subgroup analyses of multiple clinical trials support benefit. 13 A meta‐analysis of 13 studies showed that statins reduced the risk of major cardiovascular events in Stage 3 CKD (pooled hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.67–‐0.78) and stage 4 CKD (pooled HR 0.78, 95% CI 0.40–0.96) patients. There was no significant benefit in patients with Stage 5 CKD and those on dialysis, but overall, more patients with Stages 4 and 5 CKD need to be included in lipid lowering trials.…”

Section: Introductionmentioning

confidence: 99%

Use of lipid‐lowering therapies in patients with chronic kidney disease and atherosclerotic cardiovascular disease: 2‐year results from Getting to an imprOved Understanding of Low‐Density lipoprotein cholesterol and dyslipidemia management (GOULD)

Shaik

Kosiborod

Lemos

et al. 2022

Clinical Cardiology

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Background Chronic kidney disease (CKD) is a known risk factor of atherosclerotic cardiovascular disease (ASCVD). Per the 2018 American Heart Association/American College of Cardiology cholesterol guidelines, high‐risk ASCVD patients with CKD and low‐density lipoprotein cholesterol (LDL‐C) levels ≥ $\ge $ 70 mg/dL should take a high‐intensity statin with ezetimibe and/or a proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i). Objective/Methods We examined the changes in use of lipid lowering therapies (LLT) over two years in 3304 patients with ASCVD and CKD in the Getting to an imprOved Understanding of Low‐Density Lipoprotein Cholesterol and Dyslipidemia Management (GOULD) observational cohort study. Results Of those with eGFR <60 ml/min/1.73 m2, 21.6% (171/791) had intensification of LLT while 10.4% (82/791) had de‐escalation of LLT. Notably, 61.6% (487/791) had no change in LLT regimen over 2 years. Statin use was 83.2% (785/944) at baseline and 80.1% (634/791) at 2 years. Statin/ezetimibe use increased from 2.9% (27/944) to 4.9% (39/791). Statin discontinuation at 2 years was greater with lower eGFR levels across all cohorts. Conclusion Despite the recommendations of multiscociety guidelines, statin use, while high, is not ubiquitous and rates of high‐intensity statin and ezetimibe use remain low in patients with CKD. There remains a significant opportunity to optimize LLT and achieve atheroprotective cholesterol levels in the CKD population.

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Concepts and Controversies: Lipid Management in Patients with Chronic Kidney Disease

Cited by 16 publications

References 74 publications

Factors associated with renal function state transitions: A population-based community survey in Taiwan

Factors associated with renal function state transitions: A population-based community survey in Taiwan

The Relationship Between Serum Magnesium Level, Plasma Atherogenic Index and Glomerular Filtration Rate

Use of lipid‐lowering therapies in patients with chronic kidney disease and atherosclerotic cardiovascular disease: 2‐year results from Getting to an imprOved Understanding of Low‐Density lipoprotein cholesterol and dyslipidemia management (GOULD)

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