NKF KDOQI GUIDELINES

KDOQI Clinical Practice Guidelines for Managing Dyslipidemias in Chronic Kidney Disease

Abstract

The incidence of cardiovascular disease (CVD) is very high in patients with chronic kidney (CKD) disease. Indeed, available evidence for patients with Stage 5 CKD, and kidney transplant recipients, suggests that the 10-year cumulative risk of coronary heart disease is at least 20%, or roughly equivalent to the risk seen in patients with previous CVD. The Work Group concluded that the National Cholesterol Education Program Guidelines are applicable to patients with Stages 1–4 CKD. Therefore, these KDOQI guidelines target adults and adolescents with Stage 5 CKD, and kidney transplant recipients. Dyslipidemias are very common in this population, but no randomized controlled trials have examined the effects of dyslipidemia treatment on CVD. Nevertheless, evidence from the general population suggests that treatment of dyslipidemias reduces CVD, and evidence in patients with Stage 5 CKD suggests that judicious treatment can be safe and effective in improving dyslipidemias. Therefore, guidelines were developed to aid clinicians in the management of dyslipidemias, until the needed randomized trials are completed. These guidelines are divided into four sections. The first section (Introduction) provides the rationale for the guidelines, and describes the target population, scope, intended users, and methods. The second section presents guidelines on the assessment of dyslipidemias (Guidelines 1–3), while the third section offers guidelines for the treatment of dyslipidemias (Guidelines 4–5). The key guideline statements are supported by data from studies in the general population, but there is an urgent need to confirm these study results in patients with CKD. Therefore, a fourth section outlines recommendations for research. The overall strength of each guideline statement was rated according to the table below.

Table 7. Rating the Strength of Recommendations.

Grade Recommendation

A It is strongly recommended that clinicians routinely follow the guideline for eligible patients. There is strong evidence that the practice improves net health outcomes.

B It is recommended that clinicians routinely follow the guideline for eligible patients. There is moderate evidence that the practice improves net health outcomes.

C It is recommended that clinicians consider following the guideline for eligible patients. This recommendation is based on either weak evidence, poor evidence or on the opinions of the Work Group and reviewers, that the practice might improve net health outcomes.

Health outcomes are health-related events, conditions, or symptoms that can be perceived by individuals to have an important effect on their lives. Improving net health outcomes implies that benefits outweigh any adverse effects.