Iyalomhe Oshozimhede E, Saparamadu Amarasinghe Arachchige Don Nalin Samandika, Alexander G Caleb
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of General Internal Medicine, Johns Hopkins Medicine, Johns Hopkins University, Baltimore, Maryland.
Am J Kidney Dis. 2025 Apr;85(4):421-431.e1. doi: 10.1053/j.ajkd.2024.11.003. Epub 2024 Dec 31.
RATIONALE & OBJECTIVE: Chronic kidney disease (CKD) populations face an elevated risk of cardiovascular disease (CVD), yet many remain undertreated with statins for primary prevention of CVD despite meeting eligibility criteria. We examined trends in statin use for primary prevention among individuals with CKD before and after the release of the 2013 Kidney Disease: Improving Global Outcomes (KDIGO) guideline recommending statin use for lipid management in selected adults with CKD.
Cross-sectional time-trend analysis.
SETTING & PARTICIPANTS: The 2001-2020 National Health and Nutrition Examination Survey (NHANES) data permitted identification of individuals eligible for statin therapy per the 2013 KDIGO guidelines based on (1) age≥50 without self-reported CVD; (2) CKD, defined as estimated glomerular filtration rate (eGFR)<60mL/min/1.73m or albumin-creatinine ratio≥30mg/g; and (3) no dialysis in the previous 12 months.
Statin use.
Poisson regression to estimate prevalence ratios (PR) comparing the periods before and after KDIGO guideline release and after accounting for NHANES's complex survey design and sampling weights.
Among eligible individuals, statin use approximately doubled from 18.6% in 2001-2002 to 36.1% in 2007-2008, increased modestly to 40.1% in 2013-2014, then subsequently plateaued. Multivariable analyses controlling for sociodemographic and clinical characteristics and secular trends demonstrated statin use for primary prevention was higher among the insured (PR, 2.48 [95% CI 1.66-3.69]), those with hypertension (PR, 1.49 [95% CI 1.28-1.74]), and those with diabetes (PR, 1.71 [95% CI 1.52-1.92]). Statin use was more common with lower eGFR (P=0.009) and higher body mass index (P=0.003) but did not differ by sex, race, or ethnicity.
Statin use and CVD were self-reported, and our data did not capture statin intolerance nor patient-provider decision making information.
Statin use for primary prevention in CKD substantially increased before the 2013 release of KDIGO guidelines and subsequently plateaued. Use was higher among the insured and those with hypertension or diabetes.
PLAIN-LANGUAGE SUMMARY: Chronic kidney disease (CKD) affects many Americans, increasing their heart disease risk. Statins effectively reduce this risk in individuals with CKD but are underused. Our study examined statin use in individuals with CKD before and after the release of the 2013 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommending statin use for selected adults with CKD. It also examined factors influencing usage patterns. Using years of US National Health and Nutrition Examination Survey data, we found that while statin use doubled over the study period, fewer than half of eligible individuals with CKD received statins for primary prevention. Statin use was more common among those with health insurance, high blood pressure, or diabetes. This underuse highlights potential opportunities for improved risk monitoring and preventive use of statin therapy for individuals with CKD.
慢性肾脏病（CKD）患者面临心血管疾病（CVD）风险升高的问题，然而，尽管许多患者符合资格标准，但仍有许多人未接受他汀类药物进行CVD的一级预防。我们研究了2013年《改善全球肾脏病预后（KDIGO）指南》发布前后，CKD患者中他汀类药物用于一级预防的趋势，该指南推荐在特定的成年CKD患者中使用他汀类药物进行血脂管理。
横断面时间趋势分析。
2001 - 2020年美国国家健康与营养检查调查（NHANES）数据允许根据以下标准识别符合2013年KDIGO指南他汀类药物治疗资格的个体：（1）年龄≥50岁且无自我报告的CVD；（2）CKD，定义为估计肾小球滤过率（eGFR）<60mL/min/1.73m²或白蛋白 - 肌酐比值≥30mg/g；（3）过去12个月内未进行透析。
他汀类药物使用情况。
采用泊松回归估计患病率比（PR），比较KDIGO指南发布前后的时期，并考虑NHANES的复杂调查设计和抽样权重。
在符合条件的个体中，他汀类药物的使用从2001 - 2002年的18.6%增加了约一倍，至2007 - 2008年达到36.1%，在2013 - 2014年适度增加至40.1%，随后趋于平稳。多变量分析控制了社会人口统计学和临床特征以及长期趋势，结果显示，在参保者（PR，2.48 [95% CI 1.66 - 3.69]）、高血压患者（PR，1.49 [95% CI 1.28 - 1.74]）和糖尿病患者（PR，1.71 [95% CI 1.52 - 1.92]）中，用于一级预防的他汀类药物使用更为普遍。他汀类药物的使用在eGFR较低（P = 0.009）和体重指数较高（P = 0.003）的患者中更为常见，但在性别、种族或民族方面没有差异。
他汀类药物的使用和CVD情况是自我报告的，我们的数据未获取他汀类药物不耐受情况以及患者与提供者的决策信息。
在2013年KDIGO指南发布之前，CKD患者中用于一级预防的他汀类药物使用大幅增加，随后趋于平稳。在参保者以及患有高血压或糖尿病的患者中使用更为普遍。
慢性肾脏病（CKD）影响着许多美国人，增加了他们患心脏病的风险。他汀类药物可有效降低CKD患者的这种风险，但使用不足。我们的研究调查了2013年《改善全球肾脏病预后（KDIGO）指南》发布前后CKD患者中他汀类药物的使用情况，该指南推荐在特定成年CKD患者中使用他汀类药物。研究还考察了影响使用模式的因素。利用多年的美国国家健康与营养检查调查数据，我们发现，尽管在研究期间他汀类药物的使用增加了一倍，但符合条件的CKD患者中接受他汀类药物进行一级预防的不到一半。在有医疗保险、高血压或糖尿病的患者中，他汀类药物的使用更为普遍。这种使用不足凸显了改善CKD患者风险监测和他汀类药物预防性使用的潜在机会。
