All patients suffering from chronic kidney disease (CKD) should be prescribed statins in light of their heightened risk of cardiovascular disease (CVD), suggests the National Institute of Health and Care Excellence (NICE).

Statins have long been prescribed as preventative treatment after conditions such as a myocardial infarction, due to their potent ability to lower cholesterol.

Advice to offer statins to all long-term patients


A reduction in glomerular filtration rate due to impaired kidney function and increased excretion of protein in urine has been shown to elevate the risk of CVD.

“We know that a high number of people with long-term kidney problems will develop cardiovascular disease. This means they have an increased risk of suffering a fatal heart attack or stroke,” comments Professor Gillian Leng, deputy chief executive at NICE.

To preclude the possibility of these life-threatening events and thus reduce mortality from cardiovascular disease in CKD patients, preventative measures need to be implemented.

In accordance with the new quality standard published by NICE, all patients with CKD must be offered statins, and in particular, Atorvastatin. Atorvastatin is not only one of the most clinically efficacious statins – it is also the most cost-effective, which is important in systems where healthcare resources need to be rationed.

Statins: Combating cardiovascular mortality in CKD patients


The updated guidelines further iterated that physicians should ensure that patients with CKD have their blood pressure monitored and maintained within an adequate range. This may be beneficial as chronic hypertension is an important risk factor for CKD.

According to the NICE quality standard, statins need to be offered to all patients who are 18 years of age or older. Approximately 2.6 million adults in England suffer from chronic kidney disease – with approximately 60,000 premature deaths annually, as a result of the disease.

The quality standard also has additional requirements which include regular monitoring of eGFRcreatinine and the albumin/creatinine ratio (ACR) – both of which are considered as valuable markers of kidney function. Monitoring these in a timely manner not only ensures that diagnoses are not missed – it also means that therapies can be administered earlier; thus, reducing the likelihood of progression of the condition.

Currently, the treatment regime for CKD patients consists of crucial lifestyle changes such as reducing salt consumption and regulating water intake and blood pressure lowering therapies. In more advanced cases, organ transplantation or haemodialysis may be indicated in order to regain kidney function. The recommended initial dosage of statins is in the form of 20mg tablets, which should promptly be increased if no improvement is observed.

The effectiveness of statins in reducing the recurrence of myocardial infarctions or strokes has been well documented over the years. If the prescription of statins can reduce the occurrence of cardiovascular events in CKD patients, this can help reduce considerable mortality in these patients related to cardiovascular causes. MIMS

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Sources:
https://www.uptodate.com/contents/chronic-kidney-disease-and-coronary-heart-disease
https://www.nice.org.uk/news/article/statins-should-be-offered-to-everyone-who-has-chronic-kidney-disease-says-nice
https://www.nursingtimes.net/news/policies-and-guidance/offer-statins-to-chronic-kidney-disease-patients-says-nice/7020627.article
https://www.thepharmaletter.com/article/people-with-chronic-kidney-disease-should-be-offered-statins-says-nice
http://www.pulsetoday.co.uk/clinical/more-clinical-areas/renal-medicine/offer-statins-to-patients-with-ckd-nice-advises/20034905.article
http://www.telegraph.co.uk/science/2017/07/26/millions-patients-should-given-statins-orders-nice/