Abstract
BackgroundThere is little information on how target lipid levels can be achieved in end stage renal disease (ESRD) patients in a systematic, multidisciplinary fashion.MethodsWe retrospectively reviewed a pharmacist-directed hyperlipidemia management program for chronic hemodialysis (HD) patients. All 26 adult patients on chronic HD at a tertiary care medical facility were entered into the program. A clinical pharmacist was responsible for laboratory monitoring, patient counseling, and the initiation and dosage adjustment of an appropriate 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor (statin) using a dosing algorithm and monitoring guidelines. The low-density lipoprotein (LDL) cholesterol goal was ≤ 100 mg/dl. A renal dietitian provided nutrition counseling and the nephrologist was notified of potential or existing drug interactions or adverse drug reactions (ADRs). Patients received a flyer containing lipid panel results to encourage compliance. Data was collected at program initiation and for 6 months thereafter.ResultsAt the start of the program, 58% of patients were at target LDL cholesterol. At 6 months, 88% had achieved target LDL (p = 0.015). Mean LDL cholesterol decreased from 96 ± 5 to 80 ± 3 mg/dl (p < 0.01), and mean total cholesterol decreased from 170 ± 7 to 151 ± 4 mg/dl (p < 0.01). Fifteen adjustments in drug therapy were made. Eight adverse drug reactions were identified; 2 required drug discontinuation or an alternative agent. Physicians were alerted to 8 potential drug-drug interactions, and appropriate monitoring was performed.ConclusionsOur findings demonstrate both feasibility and efficacy of a multidisciplinary approach in management of hyperlipidemia in HD patients.
Highlights
There is little information on how target lipid levels can be achieved in end stage renal disease (ESRD) patients in a systematic, multidisciplinary fashion
Mortality benefits of statins has been attributed to lower lipid levels, but recent reports indicate that statins may reduce cardiovascular risk by other mechanisms, [6,7] and may reduce cancer-related mortality [8]
After 6 months, 23 of 26 patients (88%) had reached target low-density lipoprotein (LDL) cholesterol (Figure 1), compared with 15 patients (58%) at the start of the program (p = 0.015)
Summary
There is little information on how target lipid levels can be achieved in end stage renal disease (ESRD) patients in a systematic, multidisciplinary fashion. Patients on dialysis have more coronary artery disease (CAD) and CAD-related mortality than the general population [1]. Elevated low-density lipoprotein (LDL) cholesterol level is an independent risk factor for patients with end stage renal disease (ESRD) [2]. Consensus is growing for statin use in all ESRD patients with atherosclerotic disease or diabetes [9]. If used this way, over 60% of all dialysis patients might be eligible for statins [10]. Despite an acceptable safety profile [6,11], fewer than 10% of dialysis patients were prescribed statins according to USRDS and Canadian studies, [3,12] even in known coronary heart disease [13]
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