Statins and lipid-lowering strategies in cardiorenal patients

The prevalence of chronic kidney disease (CKD) is increasing alarmingly mainly as a result of an ongoing epidemic of obesity, metabolic syndrome, and diabetes mellitus. CKD is a well-recognized risk multiplier for development of cardiovascular disease (CVD), and it is widely known that CVD is the leading cause of morbidity and mortality in patients with CKD. Cardiovascular (CV) morbidity and mortality is significantly increased along the continuum of CKD, and it is more than 10 times higher in end-stage renal disease populations than in the general population. Lipid metabolism is profoundly disturbed in CKD, and there is a gradual shift to the uremic lipid profile as kidney function deteriorates, which is further modified by the presence of comorbidities such as diabetes and obesity. Apart from quantitative differences, major qualitative changes in lipoproteins can be observed, such as oxidization and modification to small and dense low-density lipoprotein (LDL), which render the particles more atherogenic. It has been noted that these abnormalities contribute to the development of CV events, and they may lead to the progression of CKD. Lipid-lowering treatment with statins in the general population has achieved important benefits both in reducing CV risk and in the prevention of CVD. Similarly, data from secondary analyses of CKD subgroups of larger prospective trials using statins also suggest an important benefit on CV outcomes and, with more conflicting evidence, on the progression of kidney disease. Preliminary results from a large randomized controlled trial of lipid-lowering therapy in CKD confirm similar benefits of treatment for dyslipidemia in patients with CKD and ESRD. The safety profile of lipid- lowering therapy with statins in CKD is not different from that observed in people with normal renal function. Hence, lipid- lowering therapy with statins should be part of the standard treatment of patients with CKD.