Title: Update Lipid Management in Chronic Kidney Disease
1Update Lipid Management in Chronic Kidney Disease
2Outline
- The relationship between CVD CKD
- NKF-KDOQI guidelines
- ATP III guidelines
- Class effect of statin in CKD ?
- Safety Dose Modification
3Epidemiology of CKD in Taiwan
Lancet 2008
LIP-FM-1011020
4Relationship Between Estimated GFR (eGFR) and
Clinical Outcomes
Death from any cause Cardiovascular events Any
hospitalization Total events 51,424 Total
events 139,011 Total events 554,651
Age-standardized event rate (per 100 person-yr)
eGFR (mL/min/1.73 m2)
Kaiser Permanente Renal Registry, n1,120,295
adults aged ?20 years Median follow-up 2.84
years
Go AS et al. N Engl J Med. 20043511296-1305.
LIP-FM-1011020
LIP-FM-1011020
5Causes of death among period prevalent patients
19971999, treated with hemodialysis, peritoneal
dialysis, or kidney transplantation.
6Epidemiological Features of CKD in Taiwan
AJKD 20074946-55
LIP-FM-1011020
7LIP-FM-1011020
8LIP-FM-1011020
9LIP-FM-1011020
10KDOQI Clinical Practice Guidelines Managing
Dyslipidemias in Chronic Kidney Disease
- Guideline 11.1. All adults and adolescents with
CKD should be evaluated for dyslipidemias. (B) - 1.2. For adults and adolescents with CKD, the
assessment of dyslipidemias should include a
complete fasting lipid profile with total
cholesterol, LDL, HDL, and triglycerides. (B) - 1.3. For adults and adolescents with Stage 5 CKD,
dyslipidemias should be evaluated upon
presentation, at 23 months after a change in
treatment or other conditions known to cause
dyslipidemias and at least annually thereafter.
(B)
11Total cholesterol LDL HDL TG/5
12the results of lipid-lowering trials are usually
generalizable to population subgroups.
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15Treatment of Adults With Dyslipidemias
- 4.1. For adults with Stage 5 CKD and fasting
triglycerides 500 mg/dL ( 5.65 mmol/L) that
cannot be corrected by removing an underlying
cause, treatment with therapeutic lifestyle
changes (TLC) and a triglyceride-lowering agent
should be considered. (C) - 4.2. For adults with Stage 5 CKD and LDL 100
mg/dL ( 2.59 mmol/L), treatment should be
considered to reduce LDL to lt100 mg/dL (lt2.59
mmol/L). (B) -
- 4.3. For adults with Stage 5 CKD and LDL lt100
mg/dL (lt2.59 mmol/L), fasting triglycerides 200
mg/dL ( 2.26 mmol/L), and non-HDL cholesterol
(total cholesterol minus HDL) 130 mg/dL ( 3.36
mmol/L), treatment should be considered to reduce
non-HDL cholesterol to lt130 mg/dL (lt3.36 mmol/L).
(C)
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17Summary
18ATP III guidelineLDL Cholesterol Goals and
Cutpoints for Therapeutic Lifestyle Changes
(TLC) Drug Therapy
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23Class effect of statin in CKD ?
24CKD Subgroup
PLANET I Prospective evaLuation of proteinuriA
and reNal function in diabETic patients with
progressive renal disease
de Zeeuw D. 2010European Renal Association-Europea
n Dialysis and Transplant Association Congress
June 27, 2010 Munich, Germany.
LIP-FM-1011020
25For PLANET I (diabetic patients), de Zeeuw
summarized
- "Atorvastatin significantly reduces the
proteinuria in these patients on top of ACE/ARB
therapy, with around a 15 reduction in
proteinuria, whereas rosuvastatin, both 10 and
40 mg, had no significant effect at all on
proteinuria."
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29JACC 2008 51(25) 2375-84
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31Case 1
- 82 year-old man
- CAD/TVD, HTN, HL, CKD (stage 4)
- Presented with cyanosis of both feet toes in
progression and gangrene change of right toes now - CTA showed severe and diffuse calcified both CFA
and SFA , suspect CTO at right SFA proximal part.
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34Final angiography
35Case 2
- 66 year-old
- Heavy smoker
- HTN with adalat OROS 2 bid, lasix 1qd, doxaben
1qd, imdur 1qd, concor 1qd ? BP 170/100 mmHg - CKD (Cr 3.5mg/dl, stage 4)
- HL
- Vertebrobasilar insufficiency
- CAD/TVD post PCI
- Bilateral ICA stenosis post CAS
- Renal echo right 7.5cm, left 9.2cm, no
hydronephrosis
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37Case 3
- 82 year-old man
- CC right hemaparesis and slurred speech in the
recent 6 months - Risk factors HTN, hyperlipidemia
- Repeated transient slurred speech and right
hemiparesis recently obvious claudication of
both lower extremities post 2-minute walking. - Cre 1.4 mg/dl (CKD stage 3)
- cholesterol 185 mg/dl
- TG 179 mg/dl
- LDL 98 mg/dl
- HDL 45 mg/dl
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40Case 4
- 72 year-old man
- HL, DM, CKD (stage 3)
- Unstable angina
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