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Offer statins to patients with CKD, NICE advises

GPs should ensure that patients with CKD are offered statins, according to the final quality standard published this week by NICE.

NICE has highlighted offering atorvastatin to patients with CKD as an important guideline for GPs to follow in order to improve the assessment and management of CKD.

The quality standard is based on published NICE guidance and lays out key areas that doctors need to address in order to ensure the best care for patients and see improvement in outcomes.

The standard recommends that all adult CKD patients are offered atorvastatin 20mg, as they have an increased cardiovascular risk and the drug has been shown to be both clinically and cost effective for the prevention of cardiovascular disease.

Professor Gillian Leng, deputy chief executive at NICE, said: ‘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.

‘It is important for healthcare professionals to speak to patients about their treatment options. The effectiveness of statins is now well proven, as is their long term safety. They may appeal to a lot of people who are at risk.’

Quality standard in full

Adults with or at risk of CKD should have their eGFRcreatinine and albumin:creatinine ratio tested at a frequency agreed with their doctor

  • Monitoring key kidney function markers enables quicker diagnosis and intervention and reduce the risks of CKD progression

Adults with CKD should be supported to keep their blood pressure within the recommended range

  • Maintaining blood pressure reduces the risk of cardiovascular disease and mortality in patients with CKD

Adults with CKD should be offered atorvastatin 20mg

  • Patients with CKD have an increased risk of cardiovascular disease and atorvastatin is a clinically and cost effective way to reduce and manage this risk

Source: NICE

Readers' comments (10)

  • So a 90 year old with an eGFR of 58, creatinine 90, TChol 3, LDL 1.7, HDL 1.5 needs a statin??

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  • Who is going to pay for this population based monitoring of CKD?It is certainly not in the £85 global sum we receive-is it going to be a new national enhanced service?

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  • AlanAlmond

    Sounds like a good idea to me..so long as noone gets too rigid about it and employs some common sense. Of cause you wouldn't be pushing a statn on a 95 year old who's got other things to worry about but given that the kidneys are basically a mesh of fine blood vessels why wouldn't you want to keep them clear of atherosclerosis, in a 53 year old for example with failing kidney function. Just seems like good medicine to me. Nice one NICE

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  • Agree with GoneDoc. This is to be welcomed and is good preventative medicine with use of Statins in high risk patients. Clinician get nervous deviating from guidelines but in my experience GPs are good at selecting patients and using guidelines judiciously and they appreciate that guidelines are just that and not 'tramlines' by shared decision making

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  • Cobblers

    What a croc of sh1t. I had to read 8:51 a few times to try and understand the non sequitur logic that spewed forth.

    The premise here is that with the higher risk of CVD in CKD patients they may benefit from statins.

    Nothing about atherosclerosis regression or fine meshes of blood vessels in kidneys.

    Now doesn't anyone want to have the evidence here? Has there been a specific trial of statin use in CKD giving reduction in CVD and associated mortality? I really don't want statistical analysis of the sideshoot of the 4S trial showed a reduction of 0.0001% in CVD events.

    A nice trial looking at CKD levels and associated mortaility with and without a statin. Has this been done?

    Or is this another massive experiment on our CKD patients?

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  • There remains an obsessional belief that statins are invaluable and that they work by lowering cholesterol. neither is likely to be true. The absolute benefit from statins in terms of reducing CV risk is around 1-2%. They probably produce this (small) benefit by virtue of their anti-inflammatory effects.

    It is time that NICE and everybody else understood that the whole basis of the cholesterol-heart hypothesis is a lie. Ancel Keys cherry-picked his results to include only the data that fitted his theory and there is a growing realisation that Yudkin was right - it's sugar, not fat, that is the villain. Indeed if you exclude trials done before 2000 then statins probably do not have any effect at all. Ally that with the trials of PCSK9 inhibitors, which drastically lower LDL cholesterol but have no effect on cardiac mortality (or indeed may worsen it) and you demolish the entire argument for statin use based on serum cholesterol. I still wish to know why the proponents of statins, whose language when confronting the sceptics is becoming more strident, will not release the raw data from their trials for independent analysis. Surely it cannot be because they have something to hide?

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  • Cobblers

    11:11am No argument from me.

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  • Also just read the other news about budget cutting- 'one area is aiming to slash its prescribing costs by 15%'... Gotta take your laughs where you can find them!

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  • AlanAlmond

    Cobblers 28 Jul 2017 10:44am
    My point wasn't an attempt at an anal analysis of the cardiovascular data, rather a statement of what might be. Most of what you do on a daily basis wouldn't be backed up by a specific double blind randomised control trial and yet you engage your brain, have a think and do something anyway, or are you so atomistic you can't practice medicine without the comforting hand of someone else's research paper? Ideas and thought exist outside of regulations, published research papers and protocol. What do you do when you are presented with an issue no one researched yet? Crap yourself ? I don't envy your dry cleaner.

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  • AlanAlmond

    ..I guess it's basic lateral speculative thinking (but obviously that won't play well in the autistic community)

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