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Dyslipidemia in Dialysis Patients
1Division of Nephrology, Department of Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas.
Seminars in Dialysis
|April 10, 2015
Summary
Dyslipidemia management in dialysis patients is complex. Standard lipid-lowering therapies may not reduce mortality, necessitating a revised approach for chronic kidney disease patients.
Area of Science:
- Nephrology
- Cardiology
- Clinical Trials
Background:
- Dyslipidemia is a known cardiovascular disease (CVD) risk factor.
- Patients with chronic kidney disease (CKD) have higher rates of dyslipidemia and CVD.
- Current guidelines for lipid management in CKD patients follow the National Cholesterol Education Program Adult Treatment Panel III (ATP III).
Purpose of the Study:
- To review the role of dyslipidemia in atherosclerosis for end-stage renal disease (ESRD) patients.
- To discuss the outcomes and limitations of major clinical trials on lipid-lowering therapy in dialysis patients.
- To propose a treatment schema for dyslipidemia in dialysis patients.
Main Methods:
- Review of existing literature and clinical trials.
- Analysis of the relationship between serum cholesterol and CVD in CKD patients.
- Discussion of the efficacy of lipid-lowering therapies in dialysis populations.
Main Results:
- Three large randomized clinical trials failed to demonstrate a mortality benefit from lipid-lowering therapy in dialysis patients.
- Despite significant reductions in low-density lipoprotein cholesterol (LDL-C), overall mortality was not reduced.
- The complex relationship between cholesterol levels and CVD in CKD patients, especially those on hemodialysis, is highlighted.
Conclusions:
- Standard lipid management guidelines may not be effective for dialysis patients.
- Uncertainty exists regarding the optimal treatment of dyslipidemia in CKD patients.
- A new treatment schema is proposed for managing dyslipidemia in dialysis patients.
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