Clinical Decisionmaking

Many kidney dialysis patients are not properly treated for high cholesterol

The risk of atherosclerotic cardiovascular disease (ASCVD) in patients with end-stage renal disease (ESRD or kidney failure) on dialysis is 10 to 20 times higher than in the general population and 5 to 10 times higher than in patients with diabetes. Application of national guidelines to reduce cardiovascular disease in kidney dialysis patients is complicated by the conflicting observations that dialysis patients have a high risk of ASCVD, but those dialysis patients who have higher serum cholesterol have lower mortality rates. This conflict may explain the results of a recent study which found that many ESRD dialysis patients in the United States are not treated for high cholesterol. The study was supported in part by the Agency for Healthcare Research and Quality (HS08365).

Whether improved cholesterol treatment rates will result in decreased cardiovascular disease events such as heart attacks among ESRD dialysis patients needs to be tested in randomized clinical trials, suggests Neil R. Powe, M.D., M.P.H., M.B.A., of Johns Hopkins University. Dr. Powe and his colleagues assessed the prevalence, treatment, and control of hyperlipidemia (elevated levels of blood lipids such as cholesterol) in 812 ESRD patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) at dialysis clinics in 19 States from 1995 to 1998.

About 40 percent of HD and 62 percent of PD patients had hyperlipidemia. Among those with hyperlipidemia, 67 percent of HD and 63 percent of PD patients were not treated for it, and only 22 percent of HD and 14 percent of PD patients were treated and controlled. Those who entered the study in 1997 or 1998, those with diabetes, males, and white patients were more likely to be treated and controlled, whereas those on PD and those with ASCVD were less likely to be treated and controlled.

See "Undertreatment of hyperlipidemia in a cohort of United States kidney dialysis patients," by Caroline S. Fox, M.D., M.P.H., J. Craig Longenecker, M.D., Ph.D., Dr. Powe, and others, in the May 2004 Clinical Nephrology 61(5), pp. 299-307.

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