LDL Cholesterol: How Low to Go in Patients With Chronic Kidney Disease?

I read with interest Dr Gregory Rutecki's response to a reader's comments (CONSULTANT, February 2007), in which he emphasized the need for early screening and treatment of cardiovascular disease in patients with chronic kidney disease (CKD). I then reviewed the Kidney Disease Outcomes Quality Initiative (K/DOQI) CKD guidelines. The position of the K/DOQI is that "all patients with CKD should be considered in the 'highest risk' group for cardiovascular disease, irrespective of levels of traditional cardiovascular disease risk factors."¹ However, I have not been able to find any specific low-density lipoprotein (LDL) cholesterol target values for this patient population. The LDL cholesterol goal for patients at highest risk (those with known cardiovascular disease and diabetes), according to the National Cholesterol Education Program, is 70 mg/dL. Should I use the same LDL cholesterol goal for my patients with CKD?

---- Karen Criminger, FNP
Boone, NC

The National Kidney Foundation suggests, based on consensus opinion, that patients with CKD be treated to secondary prevention targets. The risk for heart disease in patients with CKD is high enough that they should be treated no differently than patients with diabetes would be. Thus, the 70 mg/dL LDL cholesterol target applies to patients with CKD as well.

---- Gregory W. Rutecki, MD
Director of Medical Education Mount Carmel Health System
Columbus, Ohio
Clinical Professor of Medicine
Ohio State University
Columbus

References:

REFERENCE:

1.

K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, Stratification. 2002. Available at:

http://www.kidney.org/professionals/KDOQI/guidelines_ckd/p7_risk_g15.htm

. Accessed August 10, 2007.