(C-083) Use of Statins for Primary Prevention among Individuals with Chronic Kidney Disease in The United States: A Cross-Sectional, Time-Trend Analysis

Background: Chronic kidney disease (CKD) populations face an elevated risk of cardiovascular disease (CVD), yet many remain undertreated with statins for primary prevention–to prevent initial CVD onset–despite meeting eligibility criteria.

Objectives: We examined trends in statin use for primary prevention in CKD before and after the 2013 Kidney Disease: Improving Global Outcomes (KDIGO) guideline for specific populations with CKD considering sociodemographic and clinical factors.

Methods: Study

Design: Cross-sectional time-trend analysis

Settings and Participants: We used 2001-2020 National Health and Nutrition Examination Survey (NHANES) data to identify individuals eligible for statin therapy per the 2013 KDIGO guidelines based on: (1) age ≥50 without self-reported CVD; (2) CKD, defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2 or albumin-to-creatinine ratio ≥30 mg/g; and (3) no dialysis in the past 12 months.

Outcome: Statin use

Statistical Analysis: We used Poisson regression to estimate prevalence ratios (PR) after accounting for NHANES’ complex survey design and sampling weights.

Results: Among eligible individuals, statin use approximately doubled from 18.6% in 2001-2002 to 36.1% in 2007-2008, increased modestly to 40.1% in the 2013-2014 cycle, then subsequently plateaued. In patients with hypertension, statin use increased from 21.7% in 2001-2002 to 39.5% in 2007-2008, reached a peak of 46.7% in 2011-2012, and plateaued. For those with diabetes, statin use showed the most substantial increase, rising two and half fold from 21.4% in 2001-2002 to 54.8% in 2009-2010 and subsequently plateaued. In contrast, individuals with CKD alone had lower statin use, increasing from 10.3% in 2001-2002 to 21.8% in 2007-2008, reaching its highest level of 26.9% in 2013-2014, before declining to 19.5% in recent years. Multivariable analyses controlling for sociodemographic and clinical characteristics and secular trends demonstrated statin use for primary prevention was higher among those with hypertension (PR 1.49, CI 1.28-1.74) and diabetes (PR 1.71, CI 1.52-1.92), compared with their counterparts.

Conclusions: Despite substantial increase in statin use for primary prevention in CKD before 2013, use has plateaued since the 2013 KDIGO guideline release, although such use remains higher among those with hypertension or diabetes. Our findings highlight the need for improved CVD risk monitoring and appropriate consideration of statin therapy for individuals with CKD.