Lipid abnormalities in kidney disease and management strategies

Table 1 Common lipid profile in patients with kidney disease[18,33,34]

	CKD not on dialysis	Hemodialysis	Peritoneal dialysis	Transplant patients
Total cholesterol	Normal or elevated	Normal or low	Elevated	Elevated
Triglycerides	Elevated	Elevated	Elevated	Elevated
LDL cholesterol	Normal or elevated or low	Normal or low	Elevated	Elevated
HDL cholesterol	Low	Low	Low	Normal

CKD: Chronic kidney disease; HDL: Low high-density; LDL: Low-density lipoprotein.

Table 2 Brief summary of randomized clinical trials in patients with kidney diseases[9,35,46,47]

Trial	Study population	Intervention	Follow-up	Major findings
ALERT (2003)	Renal transplant recipients (n = 2102)	Fluvastatin (40 mg/d) vs placebo	Mean 5.1 yr	Fluvastatin group had reduced major cardiac events and cardiac death but this was not statistically significant No effect seen on all-cause mortality
4D (2005)	Hemodialysis patients with DM type II (n = 1255)	Atorvastatin (20 mg/d)	Median 4 yr	Atorvastatin did not have significant effect on CV death, non-fatal MI, non-fatal stroke and all-cause mortality
AURORA (2009)	Hemodialysis patients aged 50-80 yr (n = 2776)	Rosuvastatin (10 mg/d) vs placebo	Median 3.8 yr	Rosuvastatin had no significant effect on CV mortality, non-fatal MI, non-fatal stroke and all-cause mortality
SHARP (2011)	CKD not on dialysis (n = 6247) Hemodialysis (n = 2527) Peritoneal dialysis (n = 496)	Simvastatin 20 mg/d plus ezetimibe 10 mg/d vs placebo	Median 4.9 yr	Simvastatin plus ezetimibe significantly decreased major atherosclerotic event but had no major effect on CV mortality or all-cause mortality. Results were available for only entire population (both dialysis and non-dialysis)

ALERT: Assessment of lescol in renal transplantation; AURORA: Assessment of survival and cardiovascular events; SHARP: Study of heart and renal protection; CKD: Chronic kidney disease; CV: Cardiovascular; MI: Myocardial infarction; DM: Diabetes mellitus.

Table 3 Kidney diseases: improving global outcomes recommended doses of commonly used statins, based on doses used in trials, in patients with estimated glomerular filtration rate < 60[9,35,45-47]

	Dose (mg/d)
Fluvastatin	80
Atorvastatin	20
Rosuvastatin	10
Simvastatin/ezetimibe	20/10
Pravastatin	40
Simvastatin	40
Pitavastatin	2

Table 4 Kidney disease: Developing global guidelines recommendations for dyslipidemia treatment among chronic kidney disease groups

CKD groups	KDIGO recommendations for dyslipidemia
CKD patients not on dialysis	In adults ≥ 50 yr with eGFR ≥ 60 mL/min per 1.73 m2, treatment with statins is recommended
	In adults ≥ 50 yr with eGFR ≤ 60 mL/min per 1.73 m2, treatment with statins or statins/ezetimibe combination is recommended
	In adults 18-49 yr, treatment with statins is recommended if they have one or more of the following risk factors:
	Known coronary disease
	Diabetes mellitus
	Prior ischemic stroke
	Estimated 10-yr incidence of coronary death or non-fatal myocardial infarction > 10%
CKD patients ON dialysis	In adult CKD patients on dialysis, initiation of statin or statin/ezetimibe combination is not recommended
	In adult dialysis patients who are already on statin or statin/ezetimibe combination at the initiation of dialysis, these agents should be continued
Kidney transplant patients	In adult patients with kidney transplant, treatment with statin is recommended

Adapted from Tonelli et al[45]. CKD: Chronic kidney disease; eGFR: Estimated glomerular filtration rate.