MA KHANAM1, J RADFORD2, R CASTELINO2, MD JOSE2, A KITSOS2, J STANKOVICH2, ST ZAIDI2, L KINSMAN1, GM PETERSON2,3
1School of Health Sciences, University of Tasmania; 2School of Medicine, University of Tasmania; 3Faculty of Health, University of Tasmania, Sandy Bay, Tasmania
Aim: To examine the prescription patterns of lipid-lowering treatment among chronic kidney disease (CKD) patients within Australian general practice.
Background: A significant proportion of patients with early stages of CKD die of cardiovascular disease (CVD) before they develop end-stage kidney disease. Furthermore, abnormal lipid levels contribute to the progression of CKD. Lipid-lowering therapy reduces both kidney disease progression and the incidence of CVD in people with CKD.
Methods: MedicineInsight data 01/01/2013 to 01/06/2016 was used for this analysis. MedicineInsight is a primary care quality improvement initiative of NPS MedicineWise, that collects de-identified patient information, including prescriptions, from 557 participating general practices, providing a database of over 3.5 million Australians. We analysed the use of lipid-lowering therapy (at least one prescription during the study period) among CKD patients, with or without co-morbid conditions.
Results: 61,102 adult patients met the definition of CKD (two or more eGFR results <60ml/min/1.73m2, at least 90 days apart). The proportion of CKD patients (without co-morbidities) who had been prescribed lipid-lowering therapy was 42.7% (M41.2%, W43.7%), while prevalence of use was 69.7% among the CKD+CVD patient group (M75.3%, W64.7%), 72.2% among the CKD+Diabetes group (M70.4%, W73.6%), and 83.0% among the CKD+CVD+Diabetes group (M84.6%, W81.0%). With co-morbidities of CKD and CVD, women were 37.8% less likely to be prescribed lipid-lowering therapy compared to men (p <0.001). The use of lipid-lowering medication steadily increased with age in both genders until 80 years, then declined.
Conclusions: The rate of prescribing lipid-lowering medication in general practice-based CKD patients appears to be relatively high. However, there may be room for improvement, especially in patients without high-risk comorbidities, and females with co-existing CVD.