Target the low cholesterol
When CKD entered the QOF in 2006, we were told it was a risk factor for CHD - but nobody could tell me why.
I wondered how raised creatinine could cause CHD. So in 2007 I did an audit of 25 patients who had an eGFR below 60 but were not known to have hypertension, CHD or diabetes. I noticed:
o two patients had cancer, which may have been causing poor renal function
o three had renal causes which could explain poor EGFR
o seven had previously unknown hypertension, CHD or diabetes
o one had no explanation
o two did not attend
o 10 had high cholesterol and were given lifestyle advice and medication.
I wondered if high cholesterol might cause microvascular atheromatous deposits in renal globules - leading to high creatinine and low eGFR. The QOF requires us to bring blood pressure down for patients with CKD but from my small audit I felt cholesterol should be the target.
This year I did a reaudit of the 10 patients with high cholesterol and found:
- three were non-compliant in taking statins and their condition remained the same
- five were very compliant and their eGFR improved to greater than 60 - so they were deleted from the CKD register
- one was compliant but his eGFR did not improve - but he did have a fatty liver
- one has left the practice.
I conclude that high cholesterol may be the link between CKD and the progression to CHD.
Lowering cholesterol may not only prevent progression to CHD, but could bring the eGFR level up as well.
From Dr Archana Garg, Leyland, LancashireTarget low cholesterol