KDOQI Clinical Practice Guidelines for Managing Dyslipidemias in Chronic Kidney Disease


IN MARCH 1995, the National Kidney Foundation (NKF) launched the Dialysis Outcomes Quality Initiative (DOQI), supported by an unrestricted educational grant from Amgen, Inc, to develop clinical practice guidelines that would improve outcomes of patients on maintenance dialysis. Since their publication in 1997, the DOQI guidelines have had a significant and documented impact on the care and outcomes of dialysis patients.1 In the course of developing the DOQI guidelines, it became evident that in order to actually improve dialysis outcomes it was necessary to improve the health status of those who reach end-stage renal disease (ESRD), and that therein existed an even greater opportunity to improve outcomes for all individuals with chronic kidney disease (CKD), from its earliest onset through its various stages of progressive loss of kidney function, when the complications of CKD develop resulting in an increasing number of comorbidities with which patients with kidney failure present for dialysis. It was on this basis that, in the fall of 1999, the board of directors of the NKF approved a proposal to move the clinical practice guidelines initiative into a new phase, in which its scope would be enlarged to encompass the entire spectrum of CKD. To reflect this expanded scope, the reference to "dialysis" in DOQI was changed to "disease" and the new initiative was termed Kidney Disease Outcomes Quality Initiative (KDOQI).

To provide a unifying focus for this new initiative, it was decided that its centerpiece would be a set of clinical practice guidelines on the evaluation, classification, and stratification of CKD, which would provide a basis for the continuous care and appropriate management of patients throughout the course of progressive kidney disease. Work on the Chronic Kidney Disease: Evaluation, Classification, and Stratification guidelines began in January 2000 and the final guidelines were published in February 2002.2

It was decided from the outset that interventional guidelines for the management of the specific problems that affect patients with CKD would follow and be based on the staging and classification developed by Chronic Kidney Disease: Evaluation, Classification, and Stratification guidelines. Three such guidelines are now under various stages of development. We are proud to present the first of these interventional guidelines for the management of dyslipidemias.

Work on these guidelines began in November 2000. The Work Group appointed to develop these guidelines screened 10,363 relevant abstracts and selected 258 articles for formal structured review of content and methodology.

As detailed in the introductory comments of the Rationale for these Guidelines, they are meant to supplement the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel, ATP III) published in 2001.3 Since its launch in 1985 by the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health (NIH), NCEP has made significant strides towards its stated goal of reducing the prevalence of high blood cholesterol in the United States. However, ATP III and its older component in children (NCEP-C), without excluding or including patients with CKD, make few specific recommendations for the evaluation and treatment of dyslipidemias in CKD. Given the recommendations of the NKF Task Force on Cardiovascular Disease in Chronic Renal Disease4 that patients with CKD should be considered in the highest risk group for cardiovascular disease, it was decided from the outset of KDOQI that management of dyslipidemias in patients with kidney disease would be one of the first interventional guidelines that would be developed. The differences of the present set of guidelines from those of the ATP III and NCEP-C are given in Tables 5 and 6 of the guidelines, respectively.

On behalf of the NKF, we would like to acknowledge the considerable effort and contributions of all those who made these guidelines possible. In particular, we wish to acknowledge the following: the members of the Work Group charged with developing the guidelines, without whose tireless effort and commitment these guidelines would not have been possible; the members of the Support Group, whose input at monthly conference calls was instrumental in resolving the problems encountered in the course of the many months that it has taken to bring the guidelines to their present stage; the members of the KDOQI Advisory Board, whose insights and guidance were essential in refining and expanding the applicability of the guidelines; to Amgen, Inc, which had the vision and foresight to appreciate the merits of KDOQI and provided the unrestricted grant support for its launching and continued work since 2000; to Fujisawa Healthcare, Inc, which shared the KDOQI objective to improve the management and care of this important problem which affects patients with CKD and transplantation, and as the Primary Sponsor of the present set of guidelines provided the unrestricted funds necessary for their development; and to the KDOQI staff in New York, who worked diligently in attending to the innumerable details that needed attention on a daily basis, for coordinating and facilitating the work of everyone who has contributed to the guidelines, and in meeting the nearly impossible deadlines that have to be met in a project such as this.

A special debt of gratitude goes to Bertram L. Kasiske, MD, Chair of the Work Group, who, the perfect gentleman that he is, in his inimitable efficient and accommodating manner made the task for everyone who worked on these guidelines not only easier but a pleasant experience. His leadership, intellectual rigor, and expertise were the driving force that brought these guidelines to fruition. Special thanks are due also to Joseph Lau, MD, Director of the Evidence Review Team, for providing methodological rigor and staff support in developing the evidentiary basis of the guidelines. As the individual in charge of the review team of CKD and the present guidelines, as well as two other sets now under development, he has been the model patient and effective teacher who has helped train and graduate the members of the different Work Groups into the experts they have become in evidentiary medicine.

In a voluntary and multidisciplinary undertaking of the magnitude of KDOQI, numerous others have made important contributions to these guidelines but cannot be individually acknowledged here. On behalf of all the patients and providers who will become the ultimate beneficiaries of these guidelines, we would like to extend our sincerest appreciations to each and every one of them.

Garabed Eknoyan, MD
KDOQI Co-Chair

Adeera Levin, MD
KDOQI Co-Chair

Nathan W. Levin, MD
Emeritus Co-Chair