Statin Therapy Prescribing in Atherosclerotic Cardiovascular Disease Patients with Chronic Kidney Disease.

Abstract

Background: Evidence supporting high-intensity statin therapy in atherosclerotic cardiovascular disease (ASCVD) patients and advanced non-dialysis chronic kidney disease (CKD) is lacking. Moreover, FDA 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 18-89 years within the University of Colorado Health system between January 1, 2019 to September 30, 2020. Patients with a diagnosis of ASCVD and CKD with an active statin prescription were included and divided into two groups, eGFR <30 mL/min/1.73m² or eGFR 30-59 mL/min/1.73m². Patients on dialysis, history of organ transplant or HIV, 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% patients in the eGFR <30 mL/min/1.73m² and 64% in the eGFR 30-59 mL/min/1.73m² were prescribed high-intensity statin therapy (p-value=0.74). Among patients with eGFR <30 mL/min/1.73m² 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 <30 mL/min/1.73m² compared to eGFR 30-59 mL/min/1.73m². 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.