Clinical practice guideline for the management of lipids in adults with diabetic kidney disease: abbreviated summary of the Joint Association of British Clinical Diabetologists and UK Kidney Association (ABCD-UKKA) Guideline 2024

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Abstract

The contribution of chronic kidney disease (CKD) towards the risk of developing cardiovascular disease (CVD) is magnified with co-existing type 1 or type 2 diabetes. Lipids are a modifiable risk factor and good lipid management offers improved outcomes for people with diabetic kidney disease (DKD).

The primary purpose of this guideline, written by the Association of British Clinical Diabetologists (ABCD) and UK Kidney Association (UKKA) working group, is to provide practical recommendations on lipid management for members of the multidisciplinary team involved in the care of adults with DKD.

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Most cited references 38

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Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease

Marc Sabatine, Robert Giugliano, Anthony Keech … (2017)

Evolocumab is a monoclonal antibody that inhibits proprotein convertase subtilisin-kexin type 9 (PCSK9) and lowers low-density lipoprotein (LDL) cholesterol levels by approximately 60%. Whether it prevents cardiovascular events is uncertain.

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Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials

Cholesterol Treatment Trialists' (CTT) Collaboration, Aldo Pietro Maggioni (2011)

Summary Background Lowering of LDL cholesterol with standard statin regimens reduces the risk of occlusive vascular events in a wide range of individuals. We aimed to assess the safety and efficacy of more intensive lowering of LDL cholesterol with statin therapy. Methods We undertook meta-analyses of individual participant data from randomised trials involving at least 1000 participants and at least 2 years' treatment duration of more versus less intensive statin regimens (five trials; 39 612 individuals; median follow-up 5·1 years) and of statin versus control (21 trials; 129 526 individuals; median follow-up 4·8 years). For each type of trial, we calculated not only the average risk reduction, but also the average risk reduction per 1·0 mmol/L LDL cholesterol reduction at 1 year after randomisation. Findings In the trials of more versus less intensive statin therapy, the weighted mean further reduction in LDL cholesterol at 1 year was 0·51 mmol/L. Compared with less intensive regimens, more intensive regimens produced a highly significant 15% (95% CI 11–18; p<0·0001) further reduction in major vascular events, consisting of separately significant reductions in coronary death or non-fatal myocardial infarction of 13% (95% CI 7–19; p<0·0001), in coronary revascularisation of 19% (95% CI 15–24; p<0·0001), and in ischaemic stroke of 16% (95% CI 5–26; p=0·005). Per 1·0 mmol/L reduction in LDL cholesterol, these further reductions in risk were similar to the proportional reductions in the trials of statin versus control. When both types of trial were combined, similar proportional reductions in major vascular events per 1·0 mmol/L LDL cholesterol reduction were found in all types of patient studied (rate ratio [RR] 0·78, 95% CI 0·76–0·80; p<0·0001), including those with LDL cholesterol lower than 2 mmol/L on the less intensive or control regimen. Across all 26 trials, all-cause mortality was reduced by 10% per 1·0 mmol/L LDL reduction (RR 0·90, 95% CI 0·87–0·93; p<0·0001), largely reflecting significant reductions in deaths due to coronary heart disease (RR 0·80, 99% CI 0·74–0·87; p<0·0001) and other cardiac causes (RR 0·89, 99% CI 0·81–0·98; p=0·002), with no significant effect on deaths due to stroke (RR 0·96, 95% CI 0·84–1·09; p=0·5) or other vascular causes (RR 0·98, 99% CI 0·81–1·18; p=0·8). No significant effects were observed on deaths due to cancer or other non-vascular causes (RR 0·97, 95% CI 0·92–1·03; p=0·3) or on cancer incidence (RR 1·00, 95% CI 0·96–1·04; p=0·9), even at low LDL cholesterol concentrations. Interpretation Further reductions in LDL cholesterol safely produce definite further reductions in the incidence of heart attack, of revascularisation, and of ischaemic stroke, with each 1·0 mmol/L reduction reducing the annual rate of these major vascular events by just over a fifth. There was no evidence of any threshold within the cholesterol range studied, suggesting that reduction of LDL cholesterol by 2–3 mmol/L would reduce risk by about 40–50%. Funding UK Medical Research Council, British Heart Foundation, European Community Biomed Programme, Australian National Health and Medical Research Council, and National Heart Foundation.

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Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia

Deepak Bhatt, P Gabriel Steg, Michael Miller … (2018)

Patients with elevated triglyceride levels are at increased risk for ischemic events. Icosapent ethyl, a highly purified eicosapentaenoic acid ethyl ester, lowers triglyceride levels, but data are needed to determine its effects on ischemic events.

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Author and article information

Contributors

Sagen Zac-Varghese: sagen.zac-varghese@nhs.net

Journal

Journal ID (nlm-ta): BMC Nephrol

Journal ID (iso-abbrev): BMC Nephrol

Title: BMC Nephrology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2369

Publication date (Electronic): 6 July 2024

Publication date PMC-release: 6 July 2024

Publication date Collection: 2024

Volume: 25

Electronic Location Identifier: 216

Affiliations

[1 ]GRID grid.439624.e, ISNI 0000 0004 0467 7828, East and North Herts NHS Trust, ; Hertfordshire, UK

[2 ]University of Glasgow, ( https://ror.org/00vtgdb53) Glasgow, UK

[3 ]Swansea University, ( https://ror.org/053fq8t95) Swansea, UK

[4 ] George’s Hospital, ( https://ror.org/02507sy82) London, UK

[5 ]Royal London Hospital, ( https://ror.org/019my5047) London, UK

[6 ]Heartlands Hospital, ( https://ror.org/01bd5gh54) Birmingham, UK

[7 ]Birmingham City Hospital, ( https://ror.org/02smq5q54) Birmingham, UK

[8 ]Belfast Health and Social Care Trust, ( https://ror.org/02tdmfk69) Belfast, Northern Ireland

[9 ]Imperial College London, ( https://ror.org/041kmwe10) London, UK

[10 ]Guy’s and St Thomas NHS Foundation Trust, ( https://ror.org/00j161312) London, UK

[11 ]Barts Health NHS Trust, ( https://ror.org/00b31g692) London, UK

[12 ]University of Birmingham, ( https://ror.org/03angcq70) Birmingham, UK

[13 ] Helier Hospital, ( https://ror.org/019hb9542) Carshalton, UK

[14 ]Norwich University Hospital, ( https://ror.org/021zm6p18) Norfolkand, UK

[15 ]GRID grid.4868.2, ISNI 0000 0001 2171 1133, Queen Mary University of London, ; London, UK

[16 ]University College Hospital, ( https://ror.org/00wrevg56) London, UK

[17 ]Kings College London, ( https://ror.org/0220mzb33) London, UK

Article

Publisher ID: 3664

DOI: 10.1186/s12882-024-03664-1

PMC ID: 11227212

PubMed ID: 38971750

SO-VID: dc56940d-c345-48d4-9f14-b769024606e2

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Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 26 April 2024

Date accepted : 1 July 2024

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ScienceOpen disciplines: Nephrology

Keywords: diabetic kidney disease,lipid management,diabetes,lipids,chronic kidney disease,nephropathy

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ScienceOpen disciplines: Nephrology

Keywords: diabetic kidney disease, lipid management, diabetes, lipids, chronic kidney disease, nephropathy

Clinical practice guideline for the management of lipids in adults with diabetic kidney disease: abbreviated summary of the Joint Association of British Clinical Diabetologists and UK Kidney Association (ABCD-UKKA) Guideline 2024

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Karger: Nephrology

Most cited references 38

Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease

Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials

Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia

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