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Assessment of Vascular Function in Patients With Chronic Kidney Disease
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Concepts and Controversies: Lipid Management in Patients with Chronic Kidney Disease

Roy O Mathew1,2, Robert S Rosenson3, Radmila Lyubarova4

  • 1Columbia V.A. Health Care System, 6439 Garners Ferry Road, Columbia, SC, 29209, USA. roy.mathew@va.gov.

Cardiovascular Drugs and Therapy
|June 20, 2020
PubMed

Insights

Chronic kidney disease (CKD) increases atherosclerotic cardiovascular disease (ASCVD) risk. This review examines hyperlipidemia treatments in CKD patients, noting statin efficacy in non-dialysis CKD and the need for more research on newer agents.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Atherosclerotic cardiovascular disease (ASCVD) is a major cause of death in chronic kidney disease (CKD) patients.
  • CKD is a significant risk factor that warrants aggressive low-density lipoprotein (LDL) cholesterol management.
  • Controversy exists regarding the effectiveness of lipid-lowering therapies, particularly in dialysis patients.

Purpose of the Study:

  • To review the role of hyperlipidemia in ASCVD within the CKD population.
  • To summarize current and emerging treatment strategies for hyperlipidemia in CKD patients.

Main Methods:

  • Literature review of clinical trials and secondary analyses.
  • Focus on lipid-lowering therapies including statins, ezetimibe, and newer agents.
  • Examination of evidence in CKD stages, including dialysis and non-dialysis populations.

Main Results:

  • Clinical trials support statins (with or without ezetimibe) for reducing ASCVD events in CKD patients not yet on dialysis.
  • Limited data exists for newer cholesterol-lowering agents in the broader CKD population, with most evidence from CKD stage 3 subgroup analyses.
  • Efficacy and safety of advanced lipid-lowering therapies in dialysis patients remain largely unevaluated.

Conclusions:

  • Hyperlipidemia management in CKD requires tailored approaches based on dialysis status and CKD stage.
  • Further research is crucial to establish the role of novel lipid-lowering agents in the CKD population, especially for those on dialysis.

Keywords:
Atherosclerotic cardiovascular diseaseChronic kidney diseaseDyslipidemiaEnd-stage renal diseasePCSK9 inhibitors

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