Introduction
Chronic kidney disease (CKD) is a global public
problem [1]. Patients with CKD have higher risk of
progression to end-stage renal disease (ESRD) and
poor cardiovascular prognosis [2]. Taiwan has been
recognized as an epidemic area of kidney disease with
the highest incidence and prevalence rates of ESRD in
the world [3]. Although the nationwide CKD
Preventive Project with multidisciplinary care
program has proved its effectiveness in decreasing
dialysis incidence, mortality and medical costs, the
numbers of CKD population are still growing as the
increasing prevalence of comorbidities such as
dyslipidemia, hypertension and diabetes in Taiwan as
well as in the worldwide [4]. Therefore, the
development of effective treatment strategies is
mandatory for such high cardiovascular risk
population.
The lipid profile worsens with the declining of
glomerular filtration rate (GFR). It comprises
elevations of triglyceride (TG), low-density
lipoprotein cholesterol (LDL-C), non-high denisty
lipoprotein cholesterol (non-HDL-C) and lowering of
HDL-C. Altogether, most patients with CKD have
mixed dyslipidaemia and the lipid profile is highly
atherogenic with adverse changes in all lipoproteins
[5]. Tonelli et al. recently reports the risk of coronary
events in people with CKD is compared with those
with diabetes in a population-level cohort study [6].
European lipid treatment guideline has also
acknowledged patients with CKD as a very high risk
cardiovascular disease population and should be
treated aggressively [5].
Previous analysis found lipid-lowering treatment
may preserve GFR and may decrease proteinuria
in patients with renal disease [7]. Recent
SHARP trial found major atherosclerotic events and
major vascular events were reduced in CKD patients
on lipid-lowering treatment [8]. Because
lipid-lowering therapy has been shown to reduce the
atherosclerotic events in the patients with
cardiovascular disease (CVD) or CKD, it is mandatory
to survey the current status of lipid-lowering agents
use, which might provide new insight to treat such
high risk population. In this study we investigated the
factors associated with the presence of CKD and the
impact of CKD on clinical characteristics, lipid management
and goal attainment in patients with established
CVD.