Introduction:
Dyslipidemia is a prevalent and significant risk factor for cardiovascular disease (CVD) in patients with advanced chronic kidney disease (CKD), both of which worsen as CKD progresses. Lipid-lowering therapy (LLT), particularly statins, has shown beneficial effects in reducing low-density lipoprotein cholesterol (LDL-C), cardiovascular risk factors, microalbuminuria, proteinuria, and overall mortality in CKD patients. However, despite these benefits, a substantial proportion of CKD patients with dyslipidemia remain untreated with LLT. We aimed to evaluate the effectiveness of lipid management among pre-dialysis CKD patients at our centre, with a specific focus on whether lipid management practices vary across different socio-economic strata.
Methods:
This observational cohort study included 272 pre-dialysis CKD patients. Data were collected from patient records in the PICS and clinical portal between May 1, 2024, and May 31, 2024. Socio-economic status was categorized based on the Multiple Deprivation Indices using patients' postcodes, classifying them into least, middle-range, and most deprived areas. Descriptive and analytical statistics were applied to evaluate lipid management and identify disparities related to socio-economic status.
Results:
The cohort had a mean age of 68.6 years and was predominantly male (58.46%). The ethnic distribution was primarily White British (46.69%) and Asian (26.47%). Diabetic nephropathy (40%) and hypertensive nephropathy (12%) were the most common causes of CKD. A high prevalence of overweight individuals (79%) and type 2 diabetes (51.84%) was observed. Dyslipidemia was identified in 71.69% of patients. Despite existing guidelines, 27.21% were not receiving any LLT. Among those on LLT, 66.67% had uncontrolled lipid levels (LDL-C >2 mmol/L or non-HDL-C >2.6 mmol/L). Socioeconomic analysis revealed poorer lipid management and monitoring in patients from the most deprived areas. Of the 204 patients with lipid mismanagement, 118 (58%) were from the most deprived areas, and 57 (28%) were from middle-range areas.
Conclusions:
This study highlights significant gaps in lipid management among pre-dialysis CKD patients, with a notable disparity affecting those from socioeconomically deprived areas. Despite established guidelines, a considerable number of patients remain untreated or inadequately controlled for dyslipidemia, increasing their risk for cardiovascular events. These findings underscore the urgent need for targeted interventions and more equitable healthcare strategies to enhance lipid control, particularly in vulnerable populations. Regular monitoring and appropriate use of LLT are essential steps in reducing CVD risk and improving outcomes for CKD patients.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.