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Updated: Jun 11, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Lipids in chronic kidney disease
David Lewis1, Richard Haynes, Martin J Landray
1Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK.
Insights
Patients with chronic kidney disease (CKD) have abnormal cholesterol levels, increasing cardiovascular risk. Research is ongoing to determine if lipid-lowering therapies, like statins, can improve outcomes in CKD patients.
Area of Science:
- Nephrology
- Cardiology
- Lipidology
Background:
- Patients with chronic kidney disease (CKD) experience premature cardiovascular disease (CVD).
- Lipid metabolism is significantly disturbed in CKD patients, with elevated triglycerides, reduced HDL, and increased small, dense LDL particles.
- The relationship between lipids and vascular disease in CKD is complex and differs from the general population.
Purpose of the Study:
- To investigate the role of blood lipids in the development of vascular disease in CKD patients.
- To explore the potential of lipid modification to delay the progression of CKD.
- To evaluate the effectiveness of statins in reducing vascular and renal risk in CKD.
Main Methods:
- Review of existing randomized trials on lipid-lowering therapies in CKD.
- Analysis of data on the association between lipid fractions and vascular disease in CKD.
- Anticipation of results from the ongoing Study of Heart and Renal Protection (SHARP) trial.
Main Results:
- Randomized trials in the general population show statins reduce vascular events.
- Current evidence on lipid modification's impact on vascular disease in CKD is inconclusive.
- Data on lipid modification's effect on CKD progression is limited, primarily based on surrogate markers like proteinuria.
Conclusions:
- The relevance of blood lipids to vascular disease in CKD requires further investigation through randomized trials.
- Lipid modification may potentially slow CKD progression, but more definitive data is needed.
- The SHARP trial is expected to provide crucial insights into the benefits of statins for both cardiovascular and renal outcomes in CKD.
Abstract:
Patients with chronic kidney disease (CKD) develop premature cardiovascular disease. In the general population (without CKD), there are strong associations between cholesterol fractions and the risk of coronary disease and weaker associations with stroke. Randomised trials in the general population demonstrate that lowering blood cholesterol (chiefly with a statin) reduces the risk of vascular events. Patients with CKD differ significantly from the general population. They have markedly disturbed lipid metabolism manifesting as elevated triglyceride concentrations, reduced HDL cholesterol concentrations and a preponderance of small, dense LDL particles that are potentially more atherogenic; the observed association between lipids and vascular disease is bizarre, and is confounded by co-morbidity; the nature of the vascular disease appears less strongly associated with classical atherosclerosis. Randomised trials are required to determine the relevance of blood lipids to the development of vascular disease in CKD patients, but the results of such studies have been inconclusive to date. CKD patients are at risk of end-stage renal disease. Lipids may be involved in the progression of renal disease. Modifying them may delay the progression of CKD. The current data are based on effects on markers of progression (e.g. proteinuria). The ongoing SHARP (Study of Heart and Renal Protection) trial should provide reliable information about the effects of statins on both vascular and renal risk.
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