Chronic Kidney Disease Pathway Document Description Presented ...

Cardiovascular Risk
All patients with CKD have a greatly increased risk of developing heart disease
and other diseases of blood vessels, including strokes. For many, this is more
important than the danger of progressing to end-stage renal disease due to the
10 fold increase in cardiovascular events and mortality at CKD stage 3.
Furthermore, when events occur, mortality is higher for people with CKD and
they have less favourable outcomes from intervention such as angioplasty. This
increased risk begins at the very earliest stages, for example when there is
microalbuminuria without a reduced eGFR. The prevalence of CKD at stage 3-5
in the population is currently approximately 4.9%. However the prevalence of
CKD at stages 4-5 is approximately 0.9%. The chief reason for the reduction of
the numbers of people going on to stage 4 or 5 is due in the most part to their
cardiovascular mortality at an earlier stage. For this reason reducing
cardiovascular risk is of crucial importance to impact on mortality and as a
progressing factor for further renal deterioration.
For this reason, CVD risk calculators, including JBS2, are not recommended for
use in calculating risk in patients with CKD. CKD at stage 3-5 is in itself a marker
for CVD, therefore no calculation is needed and these patients should be
considered high risk.
Dyslipidaemia
Patients with established macrovascular disease should receive treatment for
hyperlipidaemia according to the current PCT Hyperlipidaemia Guidelines. Treat
with simvastatin 40mg, aim for cholesterol of < 4mmol/l.
Patients with diabetes and CKD but no established macrovascular disease
should be offered lipid-lowering drug treatment according to the current PCT
Hyperlipidaemia Guidelines.
Patients with CKD who do not have diabetes and who do not have established
macrovascular disease should be offered the options of lipid-lowering treatment
according to the current PCT Hyperlipidaemia Guidelines if estimated 10-year
risk of cardiovascular disease is ≥20%.
Health Economy Formulary Drug of Choice - simvastatin 40mg.
For further information see Dudley Guidelines for the Drug Treatment of
Hyperlipidaemia. http://joint.dudley.nhs.uk/cmsextra/documents/cms/222-2008-2-
22-5663216.pdf
It would follow that patients with CKD should receive lipid therapy if they are
considered to be at high risk. However, studies evidencing benefit from the use
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