However, more frequent (or less frequent) follow-up measure- ments may be appropriate based on the clinical status of the patient. There is no direct evidence that routine follow-up of lipid levels improves clinical outcomes or adherence to lipid- lowering therapy. In fact, evidence indicates that random within-patient variation in serum cholesterol levels is substantial ( 0.8 mmol/l [31 mg/dl] for total cholesterol [TC]) and therefore that such follow-up measurements may not reliably indicate good or poor compliance.10 However, some patients may prefer to know their lipid levels during follow-up, or may respond favorably to such knowledge (for example, with better adherence to recommended statin use). In the judgment of the Work Group, these considerations favor an ungraded statement. Physicians may choose to perform follow-up measurement of lipid levels in patients for whom these measurements are judged to favorably influence processes of care. Considerations for International Settings If resources are limited, priority should be given to prescribing statins to patients at risk based on clinical criteria, rather than to measuring lipid profiles at baseline or in follow-up. In the opinion of the Work Group, the frequency of pancreatitis due to severe hypertriglyceridemia among CKD patients is sufficiently low that measuring fasting TG levels can be omitted in low-resource settings. Conversely, in settings where documentation of hypercholesterolemia is required to justify prescription of statins (e.g., Japan), more liberal or more frequent measurement of serum lipids may be necessary. Suggested Audit Criteria K Proportion of adults who had a lipid profile measured within 1 month of referral. K Frequency of specialist referral for further evaluation of abnormal lipid abnormalities (e.g., fasting TG levels above 11.3 mmol/l (1000 mg/dl) or LDL-C levels above 4.9 mmol/l (190 mg/dl)). 