Shimizu Rumiko, Torii Haruki, Yasuda Daisuke, Hiraoka Yoshinori, Kitada Noriaki, Hashida Tohru, Yoshimoto Akihiro, Kita Toru, Kume Noriaki
Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Kobe Gakuin University.
J Atheroscler Thromb. 2015;22(9):949-57. doi: 10.5551/jat.29165. Epub 2015 Apr 4.
According to the Japan Atherosclerosis Society 2012 guidelines (JAS2012-GL), chronic kidney disease (CKD) has newly been added to the high-risk group in terms of atherosclerotic cardiovascular diseases. We therefore explored the lipid target level achievement rates under the JAS2012-GL in real-world clinical practice.
We retrospectively reviewed the medical charts of patients who were hospitalized at the Nephrology Department at Kobe City Medical Center General Hospital in the period from April 1, 2012 to May 31, 2013 and explored the serum lipid target level achievement rates. Patients without lipid data or those undergoing regular dialysis because of chronic renal failure were excluded. In this study, the CKD group (CKD-G) did not include CKD patients under secondary prevention for coronary heart disease (CHD) or diabetes mellitus (DM).
The CKD-G included 146 (81.1%) of the 180 enrolled patients. According to the JAS2012-GL, 100% of the CKD-G patients were categorized into the high-risk group, although only 12.1% of the CKD-G subjects were at high risk according to the JAS2007-GL. Under the JAS2012-GL, the LDL cholesterol (LDL-C) and non-HDL cholesterol (non-HDL-C) target level achievement rates for CKD-G were 71.4% and 68.1%, respectively. According to the JAS2007-GL, these rates were 81.3% and 79.1%, respectively, and, under both guidelines, these rates were 71.7% and 72.1% for primary prevention DM and 66.7% and 66.7% for CHD, respectively.
After the revision of the JAS-GL in 2012, the LDL-C and non-HDL-C target level achievement rates for CKD-G were reduced by approximately 10%; however, they remained similar to those for DM and higher than those for CHD.
根据日本动脉粥样硬化协会2012年指南（JAS2012 - GL），慢性肾脏病（CKD）在动脉粥样硬化性心血管疾病方面新被纳入高危组。因此，我们在实际临床实践中探讨了JAS2012 - GL下的血脂目标水平达成率。
我们回顾性分析了2012年4月1日至2013年5月31日期间在神户市立医疗中心综合医院肾内科住院患者的病历，探讨血清血脂目标水平达成率。排除无血脂数据的患者或因慢性肾衰竭接受定期透析的患者。在本研究中，CKD组（CKD - G）不包括冠心病（CHD）或糖尿病（DM）二级预防下的CKD患者。
180例纳入患者中，CKD - G组有146例（81.1%）。根据JAS2012 - GL，CKD - G组100%的患者被归类为高危组，而根据JAS2007 - GL，CKD - G组只有12.1%的患者处于高危状态。在JAS2012 - GL下，CKD - G组的低密度脂蛋白胆固醇（LDL - C）和非高密度脂蛋白胆固醇（non - HDL - C）目标水平达成率分别为71.4%和68.1%。根据JAS2007 - GL，这些比率分别为81.3%和79.1%，在这两个指南下，一级预防DM的这些比率分别为71.7%和72.1%，CHD的分别为66.7%和66.7%。
2012年JAS - GL修订后，CKD - G组的LDL - C和non - HDL - C目标水平达成率降低了约10%；然而，它们仍与DM组相似且高于CHD组。
