Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
Copyright © 2023 Korean Diabetes Association
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Guidelines | Population | Recommendation | Target LDL-C goals |
---|---|---|---|
KDIGO 2013 | Nondialysis CKD with age ≥50 years with | Statin±ezetimibe (1 A, 1 B) | Not recommended |
Nondialysis CKD with age 18–49 years and high-risk for ASCVD | Statin±ezetimibe (1 A, 1 B) | ||
Dialysis-dependent CKD previously not on statin treatment | Statin±ezetimibe not be initiated (2 A) | ||
Dialysis-dependent CKD previously on statin treatment | Statin±ezetimibe be continued (2 C) | ||
KT recipients | Statin (2 B) | ||
ESC 2019 | Nondialysis CKD stage 3–5 | Statin±ezetimibe (1 A) | LDL-C <70 mg/dL for moderate CKD (eGFR 30–59 mL/min) |
Dialysis-dependent CKD previously on statin treatment | Statin±ezetimibe be continued (IIa C) | ||
Dialysis-dependent CKD who are free of ASCVD | Statin treatment not recommended (III A) | LDL-C <55 mg/dL for severe CKD (eGFR <30 mL/min) | |
KT recipients | Statin (IIa B) | ||
KSoLA 2022 | Diabetic patients with target organ damage such as albuminuria and CKD | Statin as the first line treatment (I A) | LDL-C <70 mg/dL (I B) |
Study | Intervention | Population | Median follow-up, yr | Primary endpoint | Primary outcome | All-cause mortality |
---|---|---|---|---|---|---|
4D | Atorvastatin 20 mg daily (vs. placebo) | n=1,255 | 4.0 | Composite of death from cardiac causes, a fatal stroke, nonfatal MI, or nonfatal stroke | HR, 0.92 (95% CI, 0.77–1.10) | RR, 0.93 (95% CI, 0.79–1.08) |
Type 2 diabetes mellitus | ||||||
HD <2 years | ||||||
LDL 80–190 mg/dL | ||||||
AURORA | Rosuvastatin 10 mg daily (vs. placebo) | n=2,776 | 3.8 | Composite of death from cardiovascular causes, nonfatal MI, or nonfatal stroke | HR, 0.96 (95 % CI, 0.84–1.11) | HR, 0.96 (95 % CI, 0.86–1.07) |
HD >3 months | ||||||
ALERT | Fluvastatin 40 mg daily, with dose increase permitted (vs. placebo) | n=2,102 | 5.4 | Major adverse cardiac event, defined as cardiac death, nonfatal MI, or coronary revascularization procedure | RR, 0.83 (95% CI, 0.64–1.06) | RR, 1.02 (95% CI, 0.81–1.30) |
More than 6 months from KT | ||||||
Stable graft function | ||||||
No recent MI | ||||||
Total cholesterol | ||||||
155–348 mg/dL | ||||||
SHARP | Simvastatin 20 mg daily+Ezetimibe 10 mg daily (vs. placebo) | n=9,270 | 4.9 | Composite of coronary death, nonfatal MI, ischemic stroke, or any revascularization procedure | RR, 0.83 (95% CI, 0.74–0.94) | RR, 1.02 (95% CI, 0.94–1.11) |
No previous MI or coronary revascularization | ||||||
Creatinine >1.7 mg/dL (men); >1.5 mg/dL (women) | ||||||
Subgroups | Nondialysis (n=6,247) | Not reported | Same as above | RR, 0.78 (95% CI, 0.67–0.91) | Not reported | |
HD (n=2,527) | RR, 0.95 (95% CI, 0.78–1.15) | |||||
PD (n=496) | RR, 0.70 (95% CI, 0.46–1.08) |
LDL-C, low-density lipoprotein cholesterol; CKD, chronic kidney disease; KDIGO, Kidney Disease: Improving Global Outcomes; ASCVD, atherosclerotic cardiovascular disease; KT, kidney transplantation; ESC, European Society of Cardiology; eGFR, estimated glomerular filtration rate; KSoLA, Korean Society of Lipid and Atherosclerosis.
4D, The Die Deutsche Diabetes Dialyse Studie; HD, hemodialysis; LDL, low-density lipoprotein; MI, myocardial infarction; HR, hazard ratio; CI, confidence interval; RR, relative risk; AURORA, A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Haemodialysis: An Assessment of Survival and Cardiovascular Events; ALERT, The Assessment of Lescol in Renal Transplantation; KT, kidney transplantation; SHARP, Study of Heart and Renal Protection; PD, peritoneal dialysis.