Addressing Dyslipidaemia in Advanced CKD: Insights from a Secondary Care Cohort

Background: Patients with chronic kidney disease (CKD) face an elevated risk of cardiovascular disease (CVD), particularly those with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m². Aims: To assess low-density lipoprotein cholesterol (LDL-C) values and the proportion of pre-dialysis patients achieving national and international targets. Methods: This was a retrospective audit (May–October 2024) of 272 patients aged >18 years attending pre-dialysis clinic (estimated glomerular filtration rate <30 mL/min/1.73 m²) at the Renal Unit, Birmingham Heartlands Hospital. Data on age, sex, ethnicity, body mass index, smoking status, CVD status, hypertension, diabetes, lipids (including LDL-C using the Friedewald and Sampson algorithms) and lipid-lowering therapy were collected from the hospital electronic records. Statistical analyses evaluated factors that were associated with LDL-C (linear/multiple regression) and statin therapy (Chi square). Results: The median (interquartile range) calculated LDL-C values were 2.2 (1.7–2.8) mmol/L and 2.3 (1.7–2.9) mmol/L using the Friedewald and Sampson algorithms respectively. Age and statin therapy were independently associated with LDL-C. Using the Friedewald algorithm, 83.8%, 70.6% and 60.3% did not achieve LDL-C targets of 1.4 mmol/L, 1.8 mmol/L and 2.0 mmol/L respectively, these figures were higher when the Sampson algorithm was applied. Only 18 and 3 of the patients were on ezetimibe and inclisiran respectively, whilst not a single patient was on bempedoic acid or proprotein convertase subtilisin/kexin type 9 inhibitors. Conclusion: Our data highlight deficiencies in the management of LDL-C in advanced CKD. We would recommend greater awareness of LDL-C targets and the use of combination lipid-lowering therapy following optimisation of statin therapy.