Statin therapy prescribing in atherosclerotic cardiovascular disease patients with chronic kidney disease.

BACKGROUND

Evidence supporting high-intensity statin therapy in atherosclerotic cardiovascular disease (ASCVD) patients and advanced non-dialysis chronic kidney disease (CKD) is lacking. Moreover, Food and Drug Administration (FDA) labeling restricts the dosing of rosuvastatin to moderate-intensity in advanced CKD. It is unclear if these limitations impact the overall prescribing of high-intensity statin therapy in advanced CKD patients.

OBJECTIVE

This study evaluated real-world prescribing patterns of statin therapy among ASCVD patients with non-dialysis dependent stage 3a/3b and stage 4/5 CKD.

METHODS

This retrospective, cross-sectional study identified patients aged 18 to 89 years within the University of Colorado Health system between January 1, 2019, and September 30, 2020. Patients with a diagnosis of ASCVD and CKD with an active statin prescription were included and divided into two groups, estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m2 or eGFR 30 to 59 mL/min/1.73 m2. Patients on dialysis, history of organ transplant or human immunodeficiency virus, or a contraindication to statin therapy were excluded.

RESULTS

A total of 350 patients were included, 175 patients in each group. A total of 65.7% of patients in the eGFR less than 30 mL/min/1.73 m2 and 64% in the eGFR 30 to 59 mL/min/1.73 m2 were prescribed high-intensity statin therapy (P = 0.74). Among patients with eGFR less than 30 mL/min/1.73 m2 prescribed rosuvastatin, 67.6% were prescribed doses higher than the FDA-recommended dose adjustment for severe kidney dysfunction (P = 0.02).

CONCLUSION

There was no difference in the prescribing of high-intensity statin therapy in patients with eGFR less than 30 mL/min/1.73 m2 compared with eGFR 30 to 59 mL/min/1.73 m2. This aligns with current guideline recommendations. However, most prescriptions for rosuvastatin did not comply with the FDA dose restriction in patients with severe kidney dysfunction.