Managing dyslipidaemia in patients with chronic kidney disease

Area of Science:

• Nephrology
• Cardiology
• Pharmacology

Background:

• Patients with chronic kidney disease (CKD) face a heightened risk of cardiovascular events.
• Clinical evidence indicates that statins can decrease all-cause mortality and cardiovascular events in CKD populations.

Purpose of the Study:

• To review current recommendations for lipid-lowering therapy in patients with CKD.
• To clarify the appropriate use of statins, ezetimibe, and other lipid-modulating agents in CKD management.

Main Methods:

• Review of clinical studies and guidelines regarding lipid management in CKD.
• Analysis of evidence for statin, ezetimibe, fibrate, and PCSK9 inhibitor use in CKD patients with varying degrees of kidney function and ASCVD status.

Main Results:

• Lipid-lowering therapy with statin +/- ezetimibe is recommended for most CKD patients with eGFR <60 mL/min or albuminuria (≥3 mg/mmol).
• Initiation of statins is not recommended for hemodialysis patients without established ASCVD, but continuation is advised if already on therapy, especially with ASCVD.
• Fibrates should not be co-administered with statins; ezetimibe monotherapy is not recommended.

Conclusions:

• Lipid-lowering therapies, particularly statins, play a crucial role in managing cardiovascular risk in CKD.
• Careful consideration of patient status, including dialysis dependence and presence of ASCVD, is essential for optimal lipid management in CKD.
• PCSK9 inhibitors show promise for LDL cholesterol reduction without adverse renal effects, warranting further investigation.