Hilary Wu1, Mazen Sharaf2, Karen Shalansky3, Nadia Zalunardo4. 1. , BSc(Pharm), ACPR, PharmD, is with Vancouver General Hospital, Vancouver, British Columbia. 2. , BSc(Pharm), ACPR, is with UBC Hospital, Vancouver Coastal Health, Vancouver, British Columbia. 3. , PharmD, FCSHP, is with Vancouver General Hospital, Vancouver, British Columbia. 4. , MD, SM, FRCPC, is with Vancouver General Hospital, Vancouver, British Columbia.
Abstract
BACKGROUND: Chronic kidney disease (CKD) is a risk factor for cardiovascular disease. The Kidney Disease Improving Global Outcomes 2013 guidelines and the Canadian Cardiovascular Society 2016 guidelines recommend statins for primary prevention of cardiovascular disease in CKD patients aged 50 years or older who are not receiving treatment with kidney transplant or dialysis. OBJECTIVES: To evaluate statin use for patients in the Vancouver General Hospital Kidney Care Clinic (VGH KCC) and to gain insight into the KCC nephrologists' practices and perspectives regarding the prescribing of statins for patients with CKD. METHODS: The study comprised 2 parts. Part 1 consisted of a cross-sectional study of all statin-eligible patients in the VGH KCC followed by a retrospective chart review. In the chart review, data were collected for 250 statin users and 250 non-users. Logistic regression analyses were performed to determine associations between demographic variables and statin use or non-use. Part 2 was an electronic survey of VGH KCC nephrologists. RESULTS: Of the 813 statin-eligible patients, 512 (63%) were taking a statin. Patients were approximately 5 times more likely to be receiving statin therapy when it was indicated for secondary versus primary prevention (adjusted odds ratio 4.64, 95% confidence interval 2.95-7.47). Eight of the 9 KCC nephrologists completed the survey, and 7 (87.5%) of these respondents indicated that they never or rarely prescribed statins themselves to KCC patients for primary prevention. However, the same number reported that they sometimes or often suggested statin initiation to family physicians. Three of the respondents indicated agreement with guideline recommendations, but many stated that the decision for statin initiation should be individualized to the patient. Strategies to improve statin prescribing rates that were endorsed by respondents included educating family physicians, creating preprinted orders and laboratory requisitions for statin initiation, providing educational materials about statins to patients, and implementing a protocol for KCC pharmacists to counsel patients about statins. CONCLUSIONS: Many statin-eligible VGH KCC patients were not receiving statin therapy, and most of the KCC nephrologists considered statin prescribing as a role for family physicians. Within the KCC, future directions will be to develop a standardized approach to identify patients who would benefit from statin therapy, and to implement strategies to improve statin prescribing rates in appropriate patients. 2021 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.
BACKGROUND: Chronic kidney disease (CKD) is a risk factor for cardiovascular disease. The Kidney Disease Improving Global Outcomes 2013 guidelines and the Canadian Cardiovascular Society 2016 guidelines recommend statins for primary prevention of cardiovascular disease in CKD patients aged 50 years or older who are not receiving treatment with kidney transplant or dialysis. OBJECTIVES: To evaluate statin use for patients in the Vancouver General Hospital Kidney Care Clinic (VGH KCC) and to gain insight into the KCC nephrologists' practices and perspectives regarding the prescribing of statins for patients with CKD. METHODS: The study comprised 2 parts. Part 1 consisted of a cross-sectional study of all statin-eligible patients in the VGH KCC followed by a retrospective chart review. In the chart review, data were collected for 250 statin users and 250 non-users. Logistic regression analyses were performed to determine associations between demographic variables and statin use or non-use. Part 2 was an electronic survey of VGH KCC nephrologists. RESULTS: Of the 813 statin-eligible patients, 512 (63%) were taking a statin. Patients were approximately 5 times more likely to be receiving statin therapy when it was indicated for secondary versus primary prevention (adjusted odds ratio 4.64, 95% confidence interval 2.95-7.47). Eight of the 9 KCC nephrologists completed the survey, and 7 (87.5%) of these respondents indicated that they never or rarely prescribed statins themselves to KCC patients for primary prevention. However, the same number reported that they sometimes or often suggested statin initiation to family physicians. Three of the respondents indicated agreement with guideline recommendations, but many stated that the decision for statin initiation should be individualized to the patient. Strategies to improve statin prescribing rates that were endorsed by respondents included educating family physicians, creating preprinted orders and laboratory requisitions for statin initiation, providing educational materials about statins to patients, and implementing a protocol for KCC pharmacists to counsel patients about statins. CONCLUSIONS: Many statin-eligible VGH KCC patients were not receiving statin therapy, and most of the KCC nephrologists considered statin prescribing as a role for family physicians. Within the KCC, future directions will be to develop a standardized approach to identify patients who would benefit from statin therapy, and to implement strategies to improve statin prescribing rates in appropriate patients. 2021 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.
Authors: Kunihiro Matsushita; Marije van der Velde; Brad C Astor; Mark Woodward; Andrew S Levey; Paul E de Jong; Josef Coresh; Ron T Gansevoort Journal: Lancet Date: 2010-05-17 Impact factor: 79.321
Authors: Todd J Anderson; Jean Grégoire; Glen J Pearson; Arden R Barry; Patrick Couture; Martin Dawes; Gordon A Francis; Jacques Genest; Steven Grover; Milan Gupta; Robert A Hegele; David C Lau; Lawrence A Leiter; Eva Lonn; G B John Mancini; Ruth McPherson; Daniel Ngui; Paul Poirier; John L Sievenpiper; James A Stone; George Thanassoulis; Richard Ward Journal: Can J Cardiol Date: 2016-07-25 Impact factor: 5.223
Authors: Colin Baigent; Martin J Landray; Christina Reith; Jonathan Emberson; David C Wheeler; Charles Tomson; Christoph Wanner; Vera Krane; Alan Cass; Jonathan Craig; Bruce Neal; Lixin Jiang; Lai Seong Hooi; Adeera Levin; Lawrence Agodoa; Mike Gaziano; Bertram Kasiske; Robert Walker; Ziad A Massy; Bo Feldt-Rasmussen; Udom Krairittichai; Vuddidhej Ophascharoensuk; Bengt Fellström; Hallvard Holdaas; Vladimir Tesar; Andrzej Wiecek; Diederick Grobbee; Dick de Zeeuw; Carola Grönhagen-Riska; Tanaji Dasgupta; David Lewis; William Herrington; Marion Mafham; William Majoni; Karl Wallendszus; Richard Grimm; Terje Pedersen; Jonathan Tobert; Jane Armitage; Alex Baxter; Christopher Bray; Yiping Chen; Zhengming Chen; Michael Hill; Carol Knott; Sarah Parish; David Simpson; Peter Sleight; Alan Young; Rory Collins Journal: Lancet Date: 2011-06-12 Impact factor: 79.321