Undertreatment of hyperlipidemia in a cohort of United States kidney dialysis patients

C. S. Fox, J. C. Longenecker, Neil R. Powe, Michael J. Klag, Nancy E. Fink, R. Parekh, Joseph Coresh, John H. Sadler, Gerard F. Anderson, Eric B. Bass, William Briggs, Ronald Brookmeyer, Klemens Meyer, Andrew Levey, Nathan Levin, Haya R. Rubin, Paul K. Whelton, Albert W. Wu

Research output: Contribution to journalArticle

Abstract

Background: Application of national guidelines regarding cardiovascular disease risk reduction to kidney dialysis patients is complicated by the conflicting observations that dialysis patients have a high risk of atherosclerotic cardiovascular disease (ASCVD), but dialysis patients with higher serum cholesterol have lower mortality rates. Actual treatment patterns of hyperlipidemia are not well studied. Methods: We assessed the prevalence, treatment and control of hyperlipidemia in this high-risk patient population from 1995 - 1998. We measured low density lipoprotein cholesterol, treatment with a lipid-lowering agent, and prevalence of hyperlipidemia as defined by the National Cholesterol Education Program (NCEP), Adult Treatment Panel (ATP) II guidelines in 812 incident hemodialysis (HD), and peritoneal dialysis (PD) patients from dialysis clinics in 19 states throughout the United States. Results: Hyperlipidemia was present in 40% of HD and 62% of PD patients. Among subjects with hyperlipidemia, 67% of HD and 63% of PD patients were untreated and only 22% of HD and 14% of PD patients were treated and controlled. Those who entered the study in 1997 or 1998, those with diabetes, males and Caucasians were more likely to be treated and controlled, whereas subjects on PD and those with ASCVD were less likely to be treated and controlled. Conclusion: These data suggest that high rates of undertreatment exist in the United States ESRD dialysis population. Whether improved rates of treatment will result in decreased cardiovascular disease events needs to be tested in randomized clinical trials.

Original languageEnglish (US)
Pages (from-to)299-307
Number of pages9
JournalClinical Nephrology
Volume61
Issue number5
StatePublished - May 2004

Fingerprint

Hyperlipidemias
Dialysis
Peritoneal Dialysis
Kidney
Renal Dialysis
Cardiovascular Diseases
Cholesterol
Guidelines
Therapeutics
Risk Reduction Behavior
LDL Cholesterol
Population
Chronic Kidney Failure
Randomized Controlled Trials
Lipids
Education
Mortality
Serum

Keywords

  • Control
  • Dialysis
  • Epidemiology
  • ESRD
  • HD
  • Hyperlipidemia
  • PD
  • Treatment

ASJC Scopus subject areas

  • Nephrology

Cite this

Undertreatment of hyperlipidemia in a cohort of United States kidney dialysis patients. / Fox, C. S.; Longenecker, J. C.; Powe, Neil R.; Klag, Michael J.; Fink, Nancy E.; Parekh, R.; Coresh, Joseph; Sadler, John H.; Anderson, Gerard F.; Bass, Eric B.; Briggs, William; Brookmeyer, Ronald; Meyer, Klemens; Levey, Andrew; Levin, Nathan; Rubin, Haya R.; Whelton, Paul K.; Wu, Albert W.

In: Clinical Nephrology, Vol. 61, No. 5, 05.2004, p. 299-307.

Research output: Contribution to journalArticle

Fox, CS, Longenecker, JC, Powe, NR, Klag, MJ, Fink, NE, Parekh, R, Coresh, J, Sadler, JH, Anderson, GF, Bass, EB, Briggs, W, Brookmeyer, R, Meyer, K, Levey, A, Levin, N, Rubin, HR, Whelton, PK & Wu, AW 2004, 'Undertreatment of hyperlipidemia in a cohort of United States kidney dialysis patients', Clinical Nephrology, vol. 61, no. 5, pp. 299-307.
Fox, C. S. ; Longenecker, J. C. ; Powe, Neil R. ; Klag, Michael J. ; Fink, Nancy E. ; Parekh, R. ; Coresh, Joseph ; Sadler, John H. ; Anderson, Gerard F. ; Bass, Eric B. ; Briggs, William ; Brookmeyer, Ronald ; Meyer, Klemens ; Levey, Andrew ; Levin, Nathan ; Rubin, Haya R. ; Whelton, Paul K. ; Wu, Albert W. / Undertreatment of hyperlipidemia in a cohort of United States kidney dialysis patients. In: Clinical Nephrology. 2004 ; Vol. 61, No. 5. pp. 299-307.
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abstract = "Background: Application of national guidelines regarding cardiovascular disease risk reduction to kidney dialysis patients is complicated by the conflicting observations that dialysis patients have a high risk of atherosclerotic cardiovascular disease (ASCVD), but dialysis patients with higher serum cholesterol have lower mortality rates. Actual treatment patterns of hyperlipidemia are not well studied. Methods: We assessed the prevalence, treatment and control of hyperlipidemia in this high-risk patient population from 1995 - 1998. We measured low density lipoprotein cholesterol, treatment with a lipid-lowering agent, and prevalence of hyperlipidemia as defined by the National Cholesterol Education Program (NCEP), Adult Treatment Panel (ATP) II guidelines in 812 incident hemodialysis (HD), and peritoneal dialysis (PD) patients from dialysis clinics in 19 states throughout the United States. Results: Hyperlipidemia was present in 40{\%} of HD and 62{\%} of PD patients. Among subjects with hyperlipidemia, 67{\%} of HD and 63{\%} of PD patients were untreated and only 22{\%} of HD and 14{\%} of PD patients were treated and controlled. Those who entered the study in 1997 or 1998, those with diabetes, males and Caucasians were more likely to be treated and controlled, whereas subjects on PD and those with ASCVD were less likely to be treated and controlled. Conclusion: These data suggest that high rates of undertreatment exist in the United States ESRD dialysis population. Whether improved rates of treatment will result in decreased cardiovascular disease events needs to be tested in randomized clinical trials.",
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AU - Fox, C. S.

AU - Longenecker, J. C.

AU - Powe, Neil R.

AU - Klag, Michael J.

AU - Fink, Nancy E.

AU - Parekh, R.

AU - Coresh, Joseph

AU - Sadler, John H.

AU - Anderson, Gerard F.

AU - Bass, Eric B.

AU - Briggs, William

AU - Brookmeyer, Ronald

AU - Meyer, Klemens

AU - Levey, Andrew

AU - Levin, Nathan

AU - Rubin, Haya R.

AU - Whelton, Paul K.

AU - Wu, Albert W.

PY - 2004/5

Y1 - 2004/5

N2 - Background: Application of national guidelines regarding cardiovascular disease risk reduction to kidney dialysis patients is complicated by the conflicting observations that dialysis patients have a high risk of atherosclerotic cardiovascular disease (ASCVD), but dialysis patients with higher serum cholesterol have lower mortality rates. Actual treatment patterns of hyperlipidemia are not well studied. Methods: We assessed the prevalence, treatment and control of hyperlipidemia in this high-risk patient population from 1995 - 1998. We measured low density lipoprotein cholesterol, treatment with a lipid-lowering agent, and prevalence of hyperlipidemia as defined by the National Cholesterol Education Program (NCEP), Adult Treatment Panel (ATP) II guidelines in 812 incident hemodialysis (HD), and peritoneal dialysis (PD) patients from dialysis clinics in 19 states throughout the United States. Results: Hyperlipidemia was present in 40% of HD and 62% of PD patients. Among subjects with hyperlipidemia, 67% of HD and 63% of PD patients were untreated and only 22% of HD and 14% of PD patients were treated and controlled. Those who entered the study in 1997 or 1998, those with diabetes, males and Caucasians were more likely to be treated and controlled, whereas subjects on PD and those with ASCVD were less likely to be treated and controlled. Conclusion: These data suggest that high rates of undertreatment exist in the United States ESRD dialysis population. Whether improved rates of treatment will result in decreased cardiovascular disease events needs to be tested in randomized clinical trials.

AB - Background: Application of national guidelines regarding cardiovascular disease risk reduction to kidney dialysis patients is complicated by the conflicting observations that dialysis patients have a high risk of atherosclerotic cardiovascular disease (ASCVD), but dialysis patients with higher serum cholesterol have lower mortality rates. Actual treatment patterns of hyperlipidemia are not well studied. Methods: We assessed the prevalence, treatment and control of hyperlipidemia in this high-risk patient population from 1995 - 1998. We measured low density lipoprotein cholesterol, treatment with a lipid-lowering agent, and prevalence of hyperlipidemia as defined by the National Cholesterol Education Program (NCEP), Adult Treatment Panel (ATP) II guidelines in 812 incident hemodialysis (HD), and peritoneal dialysis (PD) patients from dialysis clinics in 19 states throughout the United States. Results: Hyperlipidemia was present in 40% of HD and 62% of PD patients. Among subjects with hyperlipidemia, 67% of HD and 63% of PD patients were untreated and only 22% of HD and 14% of PD patients were treated and controlled. Those who entered the study in 1997 or 1998, those with diabetes, males and Caucasians were more likely to be treated and controlled, whereas subjects on PD and those with ASCVD were less likely to be treated and controlled. Conclusion: These data suggest that high rates of undertreatment exist in the United States ESRD dialysis population. Whether improved rates of treatment will result in decreased cardiovascular disease events needs to be tested in randomized clinical trials.

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KW - Epidemiology

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