Trends of lipid-lowering drug utilization, treatment intensity and LDL-C target attainment in adults with diabetes and non-dialysis chronic kidney disease in Hong Kong.

Abstract

With evolving treatment targets, concerns over renal safety for some statins and new lipid-lowering drugs (LLDs), we aimed to evaluate the trends of statins and non-statin LLDs [ezetimibe, and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i)] utilization in individuals with diabetes and non-dialysis chronic kidney disease (CKD) in Hong Kong. We conducted a retrospective cohort study of 332,975 Chinese individuals with diabetes and non-dialysis CKD using data from Hong Kong Hospital Authority in 2002-2019. We analyzed the annual average dosage, treatment intensity (low-intensity: <30% Low density lipoprotein-cholesterol (LDL-C) reduction; moderate-intensity: 30%-49%; high-intensity: ≥50%) and attained LDL-C targets defined by annual average LDL-C value. We evaluated the age-sex standardized trends of statin and common non-statin LLD use for primary and secondary prevention across age, sex and CKD stages. Statin-users increased from 17.6% in 2002 to 71.3% in 2019 with similar trends across age, sex and CKD stages G3-5 except for the 18-49 age group having the highest proportion of non-users of LLD (39%). By 2019, the usage of ezetimibe (1.19%) and PCSK9i (0.01%) remained low. Amongst statin-users, 27.2% received moderate-intensity therapy for primary prevention and 11.2% received high-intensity therapy for secondary prevention. In 2019, 33.3% of LLD-users achieved LDL-C < 1.8 mmol/L for primary prevention and 21.3% achieved LDL-C < 1.4 mmol/L for secondary prevention. Despite the increasing use of statins, treatment gaps remain with respect to treatment intensity and LDL-C target attainment in diabetes and non-dialysis CKD calling for increased use of combination statin and ezetimibe or PCSK9i to close the treatment gaps. Dr. Aimin Yang was supported by a CUHK Impact Research Fellowship Scheme.