Dyslipidemia and Chronic Kidney Disease

Dyslipidemia in patients with chronic kidney disease (CKD) is common, characterized by high triglyceride levels and low HDL concentrations, while total and LDL cholesterol (LDL-C) are normal or low. Most CKD patients are at very high risk of cardiovascular events. CKD patients with low as well as high levels of total and LDL-C are at the highest risk of developing adverse outcomes. Thus, elevated cholesterol seems unsuitable as the sole criterion for prescription of statins in CKD patients. The decision to treat patients should be based on pretreatment risk of cardiovascular events and not solely pretreatment LDL-C. The new Kidney Disease: Improving Global Outcomes clinical practice guidelines on lipid management recommend fixed statin or statin/ezetimibe treatment in adults aged ≥50years with eGFR <60mL/min/1.73m2 but not treated with chronic dialysis or kidney transplantation. In dialysis patients, the magnitude of any relative reduction in risk appears to be substantially smaller than in earlier stages of CKD. Initiation of statin treatment is not recommended for most prevalent hemodialysis patients. Treatment escalation with higher doses of statins is not recommended because higher doses of statins have not been proven to be safe in the setting of CKD. Because LDL-C levels do not necessarily suggest the need to increase statin doses, follow-up measurement of lipid levels is not recommended.