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UK opposition leader to support snap election. News with text, video, audio and comprehension and vocabulary exercises. Before beginning to answer the questionnaire, the experts had to answer a series of questions about their medical specialty, years of professional practice, and number and characteristics of patients with dyslipidaemia treated, amongst others..

In order to analyse the group opinion regarding each question raised and for the interpretative purposes of the Likert-type scale questions, the presentation of the answers was systematised by grouping the range of possible values between 1 and 9 into 3 levels 29 : 1—3, 4—6, 7—9 Fig.

Score scale and levels of agreement and disagreement.. The data were analysed as a whole and according to the specialty of the participating doctors, comparing the answers of general practitioners GPs with those of specialist doctors. To perform the comparative analysis between both rounds, Bowker's test 30 was used, adapting McNemar's test to compare endpoints of more than 2 categories. In both cases, the level of statistical significance was 0. The data were analysed using the statistical package SAS v. Table 1 shows the results obtained. Level of agreement reached after 2 rounds by the participating experts..

CKD: chronic kidney disease; GPs: general practitioners.. Agreement was also reached on when to screen for dyslipidaemia in patients with CKD in clinical practice, because Regarding which parameters influence the choice of statin, there was agreement in which, amongst other aspects, patient profile influences the choice of statin When the data were analysed by differentiating between nephrologists and non-nephrologists, the former showed no consensus However, regarding the parameters to be considered when deciding on a statin, there was no consensus in the entire sample when considering estimated glomerular filtration rate eGFR When analysing this parameter by considering a given expert's specialty, as with the GPs, the nephrologists deemed it necessary to consider eGFR when deciding on a statin Nor was a consensus reached with regard to albuminuria in the entire sample analysed Also, no agreement was reached on measuring eGFR When the specialty was subdivided between nephrologists and non-nephrologists, the nephrologists considered evaluating eGFR Something similar happened with albuminuria, but in this parameter there were statistically significant differences amongst the groups of experts GPs In this post hoc analysis of the DIANA study, there was agreement that dyslipidaemia should be studied in patients with CKD and that it is routine practice to screen for it in this population.

This means that the participating doctors recognised the high cardiovascular risk associated with CKD, as indicated in the guidelines and consensus documents. There was also agreement that patient profile, as well as possible interaction with other drugs, should be considered when choosing a statin.

However, the nephrologists did not reach a consensus on whether patient profile influenced the choice of statin This may be due to the fact that, in general, renal patients seen by nephrologists are in more advanced stages of the disease, and these patients have a very high cardiovascular risk. Therefore, statin therapy is almost mandatory. However, there was no consensus in considering eGFR or urinary albumin excretion as factors to be taken into account in the choice of statin. However, according to the subgroups of doctors surveyed, both GPs and nephrologists did reach a consensus in considering eGFR as an element to account for in the choice of statin, but this was not achieved in non-nephrologist specialists This discrepancy may be due to different drug-prescription patterns amongst different specialists.

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It seems then that whereas GPs integrate the different prescribed treatments and clinical conditions and perform long-term patient monitoring, specialists often follow a fire-and-forget strategy, which is advocated by the latest US guidelines, which recommend starting statin therapy with fixed doses with no LDL-C goal. Alternatively, it could be inferred that amongst non-nephrologist specialists there is less knowledge that some statins show greater renal clearance and therefore require dose adjustments.. It is also surprising that there is no consensus in considering baseline albuminuria amongst any of the groups of doctors, although there are studies that indicate that statins are not homogeneous in this regard.

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All of this indicates the need for a better understanding of the implications of CKD in prescribing statins amongst specialists in order to reduce cardiovascular risk and minimise the risk of renal adverse effects in this population. Nor was it considered necessary to monitor renal function or urinary albumin excretion during follow-up after prescribing a statin, nor amongst GPs or specialists, although when analysed by subgroup, the nephrologists reached a consensus in evaluating eGFR and albuminuria during follow-up of their patients.

In this regard, some observational studies have shown an increased risk of renal events acute kidney failure with the use of statins, 14,35,36 but this has not been observed in other clinical trials, prospective studies or meta-analyses. Although it may seem that the effects of statins on renal function are minor, many of the positive studies stem from the analysis of clinical trials designed to evaluate cardiovascular events in which the measure of renal function was limited to the eGFR. With respect to specific statins, some evidence indicates a beneficial effect on renal function in some, 17,19 and a neutral effect in others.

Finally, a recent meta-analysis indicates that high-efficacy statins might have a beneficial effect on decreased renal function but not those of medium-low efficacy in patients with CKD. As mentioned above, patients with CKD have a higher risk of developing adverse effects when treated with statins 15 ; therefore it is important to choose a statin with sufficient hypocholesterolaemic efficacy, with no risk of accumulation in the presence of CKD, and with a low risk of drug interactions that, if possible, have shown a beneficial effect on the progression of CKD.

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In this regard the European guidelines for the treatment of dyslipidaemia recommend the use of statins that show a lower renal excretion, such as fluvastatin, atorvastatin and pitavastatin, in patients with CKD, 39 although they do not refer to dose adjustments in the presence of CKD. The Spanish consensus document on CKD is similar in this sense.


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This study's main limitation is that the questionnaire was not specifically designed to show whether the presence of CKD had any effect on screening for dyslipidaemia or on selecting a hypolipidaemic treatment. Nor did it specifically ask whether there are differences between statins regarding renal function or albuminuria, or regarding possible differences between high- and low-medium-efficacy statins; this should be addressed in a future study.

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However, the answers contained in this analysis are novel, based on clinical practice, and allow us to detect training-related deficiencies of prescribing doctors in terms of the appropriate choice of a statin in patients with CKD. By contrast, the number of nephrologists included is small, and therefore the results of the study may not be extrapolated to all nephrologists. In summary, the data from this study show that there is a consensus on the need to detect dyslipidaemia in CKD, thus indicating that doctors recognise that the condition involves stratifying patients as being at a high or very high cardiovascular risk, and therefore, the need to prescribe statins in this population.

However, there does not appear to be adequate knowledge about the clinically relevant differences that exist amongst different statins in relation to CKD. This study was funded by Laboratorios Esteve , which did not, however, participate in the preparation of the survey, statistical analysis, discussion of results or the writing of the article, which were the responsibility of the committee of experts who signed as authors of the article..

All authors state that there are no conflicts of interest in the writing of the manuscript, and any type of financial or personal relationship that might interfere with the study has been specified.. Home Articles in press Archive. ISSN: Previous article Next article. November - December Pages Delphi consensus on the diagnosis and management of dyslipidaemia in chronic kidney disease patients: A post hoc analysis of the DIANA study.

Download PDF. Corresponding author. This item has received. Under a Creative Commons license. Article information. Table 1. Background and objectives This post hoc study analysed the perception of the relevance of chronic kidney disease CKD in dyslipidaemia screening and the choice of statin among primary care physicians PCPs and other specialists through a Delphi questionnaire.

Methods The questionnaire included 4 blocks of questions concerning dyslipidaemic patients with impaired carbohydrate metabolism. This study presents the results of the impact of CKD on screening and the choice of statin. However, there was no consensus in considering the estimated glomerular filtration rate eGFR although there was consensus among PCPs and nephrologists , or considering albuminuria when selecting a statin, or in determining albuminuria during follow-up after having initiated treatment with statins although there was consensus among the nephrologists.

Conclusions The consensus to analyse the lipid profile in CKD patients suggests acknowledgement of the high cardiovascular risk of this condition. Palabras clave:. Introduction Patients with chronic kidney disease CKD have a high rate of cardiovascular morbidity and mortality 1—3 ; therefore in different clinical guidelines this disease is considered a powerful and common predictor of cardiovascular events and mortality, 4 which involves stratifying these patients as being at a high or very high risk of cardiovascular disease, and a tight control of different risk factors, including dyslipidaemia.

Methods Study design The modified Delphi method 23 was used to achieve the widest possible consensus of a broad panel of doctors experts in the management of dyslipidaemia. The expert doctors were able to confidentially contrast their personal opinions with the panel's aggregate opinion when responding to the second round and to reconsider, if deemed appropriate, their initial criteria on issues that had not been agreed upon.

The study was carried out in 4 phases: a formation of the scientific committee, responsible for proposing the panel of experts and creating the survey items; b formation of an expert panel of professionals from 5 medical specialties cardiology, endocrinology, internal medicine, nephrology, and family and community medicine , with a special interest and experience in the field of dyslipidaemia, with the exclusive task of completing the survey; c on-line survey in 2 rounds; and d compilation, analysis of results and discussion of conclusions in a face-to-face session of the scientific committee.

Development of the questionnaire The authors of this study made up the project's scientific committee owing to their individual career and professional experience in this field.

https://lizingperne.tk Algorithm for current management of dyslipidaemia, in particular in patients with impaired glucose metabolism: detection, therapeutic approach, monitoring and follow-up 57 items. Opinion on the relative importance of the factors taken into account when prescribing and following up on statin therapy 39 items. Opinion on the profile of statins in the treatment of dyslipidaemia in patients with impaired glucose metabolism 16 items.

Recommendations for selecting the hypolipidaemic treatment of choice for patients with impaired glucose metabolism 24 items. In this study we collected the results of the questions related to the screening and management of dyslipidaemia in patients with CKD. Expert panel selection Panel experts were proposed by the scientific committee with the criterion of being representatives of their medical specialty with decision-making on the clinical status of the study, professional recognition for their experience and scientific opinion leadership in the subject-matter and special interest in the field of dyslipidaemia.

The study was carried out between February and June , with electronic mail as a means of distribution. Before beginning to answer the questionnaire, the experts had to answer a series of questions about their medical specialty, years of professional practice, and number and characteristics of patients with dyslipidaemia treated, amongst others. Analysis and interpretation of the results In order to analyse the group opinion regarding each question raised and for the interpretative purposes of the Likert-type scale questions, the presentation of the answers was systematised by grouping the range of possible values between 1 and 9 into 3 levels 29 : 1—3, 4—6, 7—9 Fig.

Score scale and levels of agreement and disagreement. Level of agreement reached after 2 rounds by the participating experts. CKD: chronic kidney disease; GPs: general practitioners. Foley, P.