Statins and lipid-lowering strategies in PD

Both traditional and nontraditional cardiovascular risk factors are considered to contribute to the high prevalence of cardiovascular disease (CVD) in peritoneal dialysis (PD) patients, and CVD is a major cause of both morbidity and mortality in this patient population. Among traditional risk factors, lipid disturbances are very common in patients with chronic renal failure and PD patients have in general, compared to hemodialysis (HD) and nondialyzed patients, an even more atherogenic lipid profile. The pathogenesis of the lipid disturbances in PD patients is not completely understood, but both the protein loss in the dialysate, and the glucose absorption from the dialysate may contribute to these alterations. Hydroxymethylglutaryl coenzyme A reductase inhibitors, more commonly known as statins, are effective to reduce low density cholesterol levels in PD patients and have few side effects. The use of statins is associated with reduced mortality in PD patients, but so far no large randomized controlled trial has been performed concerning the effects on clinical outcome in PD patients (except for the fact that 496 patients in the SHARP trial were treated with PD). In addition, except from their lipid lowering effects, statins also have pleiotropic effects, independent of their lipid lowering effect, that theoretically have beneficial effects on the peritoneal membrane remodeling. Use of alternative osmotic agents as well as nutritional interventions has also been reported to improve the lipid profilein PD patients.