He brought along a health summary from his previous GP which listed his past medical history as CKD, hypertension and gout. His medications are irbesartan 150mg daily and allopurinol 100mg daily. Graeme does not smoke and has minimal alcohol intake. Graeme does not identify as Aboriginal or Torres Strait Islander. At the initial visit, his BP was recorded as 132/72.
There is no microalbuminuria.
According to the recently published Chronic Kidney Disease (CKD) Management in Primary Care guidance (2020), despite his relatively modest 5 year CV risk, Graeme SHOULD be offered a statin.
In relation to CKD and CVD, there is strong evidence that both reduced eGFR and significant albuminuria are independent risk factors for CVD. The guidelines state that CKD is a more important risk factor for CVD than diabetes, and that even early-stage CKD constitutes a significant risk factor for CV events and death. They recommend a CV risk assessment be performed on adults without existing cardiovascular from age 45 years (and from age 35 years for Aboriginal and Torres Strait Islander people).
NOTE: Adults already known to be at increased absolute risk of CVD (including moderate or severe CKD [macroalbuminuria, and/or eGFR <45] and diabetes with microalbuminuria) do not need a CV risk assessment performed.
More specifically, in terms of lipid management, the guidelines state that a statin should be offered to all patients aged ≥50 years with any stage of CKD, irrespective of lipid levels. This should be done in a shared decision model of care.
The management of CKD, as with Graeme above, is a continually evolving field, and is one of the many clinical updates as part of the 2022 Hot Topics course. Join us from the comfort of your own home on Saturday 25 June for our next Hot Topics GP Update. This course is run in partnership with NB Medical (UK) and aims to update GPs with the latest developments in primary care to help you deliver better patient care.
The course revolves around short, engaging presentations that merge recent clinical evidence with real-life clinical scenarios.
And like all Medcast courses, all content is completely independent and free of external influence.
Click here to find out more about Hot Topics. We look forward to seeing you there!