Bert Vorstman MD, MS, FAAP, FRACS, FACS
A new recommendation for patients with chronic kidney disease asks physicians to perform a full lipid profile at first presentation of the condition. The new recommendations come from a work group working on behalf of the Kidney Disease: Improving Global Outcomes organization.
According to the guidelines, measuring lipid status at the discovery of chronic kidney disease will not improve clinical outcomes. It will, however, improve the health of people who suffer form dyslipidemia as part of their condition. The procedure is noninvasive and inexpensive, and the potential benefit is worth the small inconvenience or additional cost.
The work group that presented the recommendation believed that the low quality of supporting evidence was not a problem because of the low cost and low risk of the procedure. Follow up lipid measurement was not recommended, except in those cases where doctors believed a new treatment may be warranted or a new condition has developed.
The guidelines also made recommendations in statin treatment, which are different depending on the age of the patient. For those ages 50 and older with an estimated glomerular filtration rate below 60 mL/min/1.73m2, but who are not on dialysis or awaiting transplant, treatment with a statin alone is sufficient, or treatment with statins combined with ezetimibe.
For those ages 18 to 49, statin treatment is only recommended if other conditions, like diabetes mellitus, coronary disease or an ischemic stroke, are present. Adults on dialysis should not be treated with statins alone or statins with ezetimibe, due to inconclusive benefits of the treatment on patients undergoing dialysis. However, patients who begin dialysis and are already taking these medications should continue.
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