Abstract 246: Single Center Study of Statin Use Among Renal Transplant Recipients


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Abstract

Background: Cardiovascular disease accounts for 50-60% of deaths among renal transplant recipients. Based on the ALERT trial, 2013 Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend statin treatment in adult renal transplant recipients. The rate of statin prescription in the renal transplant recipients is ill-defined. The aim of our study was to assess the rate of statin use, and its predictors among renal transplant recipients, in a single tertiary care center. For comparative purposes we also obtained data on aspirin use, another common cardiac preventive therapy.Methods: By retrospective chart review we collected the following data on patients who underwent renal transplantation in the year 2015 and 2016: demographics, history including hypertension, diabetes mellitus (DM), smoking, coronary artery disease (CAD) and coronary revascularization. In addition, data on the following variables were recorded pre- and post-transplantation: lipid profile, use of statin and non-statin medications along with dose, statin allergy, liver disease, immunosuppressant class and dose and aspirin use. For all parameters, the latest post-transplant data (until December 2017) was included.Results: A total of 233 patients were included: median age of 58 (21-79) years, male 66.5%, DM 47%, hypertension 93%, CAD 22%, revascularization 12%, statin intolerance 2% and liver disease 9%. There were 80 (34%) patients on a statin pre-transplant and 95 (41%) patients were on post-transplant. Of 153 patients not on statin pre-transplant, 28 were initiated on a statin post- transplant. Of 80 patients on statin pre transplant, 67 remained on statin post- transplant. Overall, there was 18% increase in patients on statins post- transplantation. Among patients with CAD, 36/52 (69%) patients were on a statin pre-transplant and 40/52 (77%) post-transplant. Among those with diabetes, 54/110 (49%) were on a statin pre-transplant and 62/110 (56%) post- transplant. In comparison, 123 (53%) patients were on aspirin pre-transplant and 165 (70%) patients were on it post-transplant. Based on logistic regression model, the predictors of statin prescription pre-transplant were DM and revascularization, and post -transplant was increasing age, DM. Use of specific class of immunosuppressants did not affect prescription of statin. Lipid panel was only available for 30% of patients pre-transplant and 40% post-transplant.Conclusion: In this high risk cohort, a significant proportion of patients who were statin eligible including diabetics, were not prescribed statin. Less than half of renal transplant recipients had a lipid panel documented pre and post- transplant. Patterns of use of cardioprotective medications in the renal transplant population, and its relation to renal and cardiac outcomes needs further study.

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