Researchers found that almost 40 per cent of eligible patients 50 years and older were not receiving a protective heart medication.
Statins can prevent heart conditions among patients with chronic kidney disease who have not started dialysis or received a kidney transplant. Yet, new research from Vancouver Coastal Health Research Institute researcher Dr. Hilary Wu indicated that these patients were often not receiving this potentially life-saving medication.
Wu’s study, published in the Canadian Journal of Hospital Pharmacy, highlights the need for new oversight and protocols when it comes to prescribing statins to older adult patients with chronic kidney disease.
“While we know the benefits of statins for chronic kidney disease patients who have had a previous heart attack or stroke, statin use can also help prevent these serious conditions among older patients who have not had any cardiovascular events.”
Chronic kidney disease happens when there is a loss of kidney function, which, in severe cases, can lead to kidney failure and death. Diminished kidney function allows wastes, excess fluids and electrolytes to build up in the body. Chronic kidney disease patients often have atherosclerotic disease, where cholesterol causes plaque deposits that narrow artery walls, increasing the risk of heart attacks and strokes.
Change is needed for statin prescription rates to rise
Statins are a prescribed medication class that lowers cholesterol levels in the blood and reduces the risk of heart disease and stroke. Interest in this medication class rose after the 2011 SHARP clinical trial, which linked statins to a reduction in cardiovascular events among patients with chronic kidney disease.
Canadian Cardiovascular Society guidelines now recommend statins for patients with chronic kidney disease aged 50 and older who are not treated with a kidney transplant or dialysis.
Wu’s study found that, of the 813 patients aged 50 and older who attended the Vancouver General Hospital Kidney Care Clinic (KCC) for treatment and were eligible for statins, only 63 per cent were taking the medication. In addition, seven out of the nine KCC nephrologists surveyed in the study stated that they never or rarely prescribed statins to KCC patients before a cardiovascular condition is diagnosed.
“Many nephrologists said that they felt statin prescription fell more into the scope of family physicians.”
Several factors contributed to surveyed nephrologists’ reluctance to prescribe the cholesterol-reducing medication, says Wu. Given the limited frequency of KCC visits, they felt that prescribing and monitoring medication adherence and potential adverse events would be better performed by patients’ family physicians.
However, Wu’s study found an openness among nephrologists to implement strategies to support greater statin use among KCC patients. Strategies they endorsed included “educating family physicians; creating preprinted orders and laboratory requisitions for statin initiation; providing educational materials about statins to patients; and implementing a protocol for KCC pharmacists to counsel patients about statins.”
“Our study shows that we need a more detailed discussion with nephrologists about the risk factors they look for when determining if someone is a good candidate for statin use, and we need to promote statin prescribing among patients who could benefit from it.”
“We also need to provide education to family physicians, potentially in the form of a letter that notifies them if the nephrologist recommends statin use and at what dosage,” says Wu.
Moving forward, Wu plans to develop these materials to support the care of older chronic kidney disease patients receiving treatment through the KCC, and to continue to monitor statin prescribing rates. She thanks Mazen Sharaf, Dr. Karen Shalansky and Dr. Nadia Zalunardo for their support and expertise in conducting this study.
