Lipid abnormalities and cardiovascular risk in renal disease

The recent 4D study failed to provide definitive evidence for benefit of statin use in type 2 diabetics on dialysis. This finding stands in stark contrast to a number of other observations in patients with early stages of chronic kidney disease where substantial benefit of statins had been documented. Here we discuss some potential explanations for the unexpected finding of the 4D study and for the negative association between below average total cholesterol and vascular mortality among dialysis patients. Admittedly, in the absence of definite evidence in dialysis patients, we still conclude that the administration of statins is appropriate in patients with manifest coronary disease.