Australian and New Zealand Living Guideline cholesterol‐lowering therapy for people with chronic kidney disease (CARI Guidelines): Reducing the evidence‐practice gap

• Published in: Nephrology (Carlton, Vic.) Vic.), 2024-08, Vol.29 (8), p.495-509
• Main Authors: Cashmore, Brydee, Tunnicliffe, David J., Palmer, Suetonia, Blythen, Llyod, Boag, Jane, Kostner, Karam, Krishnasamy, Rathika, Lambert, Kelly, Miller, Andrea, Mullan, Judy, Patu, Maira, Phoon, Richard K. S., Rix, Liz, Trompf, Natasha, Johnson, David W., Walker, Robert, Lee, Vincent, Coolican, Helen, Cullen, Vanessa, Fortnum, Debbie, Hassan, Hicham, Jun, Min, Craig, Jonathan, Light, Casey, Nguyen, Thu, Scuderi, Carla, See, Emily, Viecelli, Andrea, Walker, Rachael
• Format: Article
• Language: English
• Subjects: Cardiovascular diseases; Cholesterol; cholesterol lowering therapy; chronic kidney disease; clinical practice guideline; Decision making; International standards; Kidney diseases; Rhabdomyolysis; Statins
• ISSN: 1320-5358; 1440-1797; 1440-1797
• DOI: 10.1111/nep.14295

Aim People with chronic kidney disease experience high rates of cardiovascular disease. Cholesterol‐lowering therapy is a mainstay in the management but there is uncertainty in the treatment effects on patient‐important outcomes, such as fatigue and rhabdomyolysis. Here, we summarise the updated CARI Australian and New Zealand Living Guidelines on cholesterol‐lowering therapy in chronic kidney disease. Methods We updated a Cochrane review and monitored newly published studies weekly to inform guideline development according to international standards. The Working Group included expertise from nephrology, cardiology, Indigenous Health, guideline development and people with lived experience of chronic kidney disease. Results The guideline recommends people with chronic kidney disease (eGFR ≥15 mL/min/1.73 m2) and an absolute cardiovascular risk of 10% or higher should receive statin therapy (with or without ezetimibe) to reduce the risk of cardiovascular events and death (strong recommendation, moderate certainty evidence). The guidelines also recommends a lower absolute cardiovascular risk threshold (≥5%) for Aboriginal and Torres Strait Islander Peoples and Māori with chronic kidney disease to receive statin therapy (with or without ezetimibe) (strong recommendation, low certainty evidence). The evidence was actively surveyed from 2020–2023 and updated as required. No changes to guideline recommendations were made, with no new data on the balance and benefits of harms. Conclusions The development of living guidelines was feasible and provided the opportunity to update recommendations to improve clinical decision‐making in real‐time. Living guidelines provide the opportunity to transform chronic kidney disease guidelines. Summary at a glance In people >30 with chronic kidney disease not requiring dialysis and a 5‐year cardiovascular risk ≥10% cholesterol‐lowering therapy is effective at preventing death and cardiovascular events with minimal harms. Indigenous populations should receive cholesterol‐lowering therapy at a lower absolute cardiovascular risk (≥5%) due to a higher burden of cardiovascular disease.