Potential effects of reclassifying CKD as a coronary heart disease risk equivalent in the us population

Meredith C. Foster, Andreea M. Rawlings, Elizabeth Marrett, David Neff, Morgan E. Grams, Bertram L. Kasiske, Kerry Willis, Lesley A. Inker, Josef Coresh, Elizabeth Selvin

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13 Scopus citations


Background Persons with chronic kidney disease (CKD) are at high risk for cardiovascular disease events, but are not classified as such in current US cholesterol treatment guidelines. We examined potential effects of modified guidelines in which CKD was considered a "coronary heart disease (CHD) risk equivalent" for risk stratification. Study Design Nationally representative cross-sectional study. Setting & Participants 4,823 adults 20 years or older from the 2007-2010 National Health and Nutrition Examination Survey. Predictors Cardiovascular risk stratification based on current US cholesterol treatment guidelines and 2 simulated scenarios in which CKD stages 3-5 or CKD stages 1-5 were considered a CHD risk equivalent. Outcomes & Measurements Proportion of persons with low-density lipoprotein (LDL) cholesterol at levels above treatment targets and above the threshold for lipid-lowering therapy initiation, based on current guidelines and the 2 simulated scenarios. Results Under current guidelines, 55.1 million adults in 2010 did not achieve the target LDL cholesterol goal. Of these, 25.2 million had sufficiently elevated levels to meet recommendations for initiating lipid-lowering therapy; 12.1 million were receiving this therapy but remained above goal. When CKD stages 3-5 were considered a CHD risk equivalent, 59.2 million persons were above target LDL cholesterol goals, with 28.5 million and 13.3 million meriting therapy initiation and intensification, respectively. When CKD stages 1-5 were considered a CHD risk equivalent, 65.2 million adults were above goal, with 33.9 million and 14.4 million meriting therapy initiation and intensification, respectively. Limitations CKD and LDL cholesterol defined using a single laboratory value. Conclusions Many adults in the United States currently do not meet recommended goals for LDL cholesterol levels. Modifying the current cholesterol guidelines to include CKD as a CHD risk equivalent would lead to a substantial increase in both the number of persons with levels above LDL cholesterol treatment targets and those recommended to initiate lipid-lowering therapy.

Original languageEnglish (US)
Pages (from-to)753-760
Number of pages8
JournalAmerican Journal of Kidney Diseases
Issue number5
StatePublished - May 2014

Bibliographical note

Funding Information:
Support: This study was supported by the National Kidney Foundation (grant to Johns Hopkins) and Merck, Sharp and Dohme Corp, a subsidiary of Merck & Co Inc, Whitehouse Station , NJ (professional service agreement to the National Kidney Foundation). Dr Foster was supported in part by a National Institutes of Health/National Heart, Lung and Blood Institute Cardiovascular Epidemiology Training Grant ( T32HL007024 ). Dr Grams receives support from the National Institute of Diabetes and Digestive and Kidney Diseases (Grant K08DK092287 ). The NHANES is funded by the NCHS, Centers for Disease Control and Prevention, Department of Health and Human Services.


  • Chronic kidney disease
  • Index Words
  • National Health and Nutrition Examination Survey (NHANES)
  • cholesterol treatment guidelines
  • coronary heart disease (CHD) risk equivalents
  • guideline implementation
  • low-density lipoprotein (LDL) cholesterol
  • public health

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