Published 1 October 2009, doi:10.1136/bmj.b4010
Cite this as: BMJ 2009;339:b4010

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Patients first

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Statins are recommended for the secondary prevention of cardiovascular disease in all patients with chronic kidney disease. But the case for statins in primary prevention is much less certain, as Andrew Connor and Charlie Tomson point out, and doctors should come clean with patients about this uncertainty (doi:10.1136/bmj.b2949). The direction of causality between chronic kidney disease and cardiovascular disease remains unknown, many risk scores exclude patients with kidney disease, and cofactors such as malnutrition and inflammation may exacerbate the risk. Until the ongoing Study of Heart and Renal Protection (SHARP) reports, there’s too little evidence to extrapolate the known benefits of lipid lowering in the general population to patients with severe chronic kidney disease.

Another pitfall when managing patients with chronic kidney disease is failure to seek specialist help until it’s too late. In a quality improvement report nephrologist Brian Lee and analyst Ken Forbes describe how they . . . [Full text of this article]

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Be careful about reading health books. You may die of a misprint.

BM Hegde
bmj.com, 2 Oct 2009 [Full text]

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