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Offer statins to chronic kidney disease patients, says NICE

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Clinicians should offer statins to patients with chronic kidney disease (CKD), under new treatment standards for the condition from the National Institute for Health and Care Excellence.

NICE has published an updated quality standard today that it said aimed to improve the assessment and management of CKD in adults.

“It is important for healthcare professionals to speak to patients about their treatment options”

Gillian Leng

According to the revised standard, all adults with the long-term condition should now be offered statins, specifically atorvastatin, to manage their increased risk of cardiovascular disease (CVD).

Around 2.6 million people in England have CKD and about 60,000 people die prematurely each year because of the renal disease, which is associated with ageing.

Research has shown there is a clear link between reduced kidney function and CVD, said NICE.

It is urging healthcare professionals to discuss statin therapy with everyone who is diagnosed with CKD.

Atorvastatin 20mg is recommended as the preferred initial high-intensity statin because it is both clinically and cost effective, said the institute.

NICE added that nurses and other health professionals should increase the dose if an adequate response to treatment was not achieved and estimated Glomerular Filtration Rate (eGFR) was 30ml/min/1.73 m2 or more.

Professor Gillian Leng, deputy chief executive at NICE, said: “We know that a high number of people with long-term kidney problems will develop cardiovascular disease. This means they have an increased risk of suffering a fatal heart attack or stroke.

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Gillian Leng

“It is important for healthcare professionals to speak to patients about their treatment options,” she said. “The effectiveness of statins is now well proven, as is their long-term safety. They may appeal to a lot of people who are at risk.”

The update includes three statements describing priority areas to improve care quality for CKD in those aged 18 and over.

The other statements in the new CKD quality standard include that adults with CKD or who are at risk of it should have their eGFRcreatinine and albumin:creatinine ratio tested at a frequency agreed with their healthcare professional.

In addition, the standard states that healthcare professionals should support adults with CKD to keep their blood pressure within the recommended range.

The quality standard on the assessment and management of CKD was first published in 2011 and last revised in 2014.

However, the latest version is much shorter than its predecessors. Previous versions contained 10 statements, covering areas such as education, care planning, referral to specialist care, psychosocial support, and personalisation of care.

Eight of these statements have now been removed from the 2017 version of the standard, with two retained and the new one on statins added.

As part of the update process, a four-week public consultation on the proposed update was held between 1 and 28 March this year. A report on the consultation revealed that concerns were raised by renal charities and the Royal College of Nursing about the removal of the eight other statements.

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