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Lipid-Lowering Therapies in Patients with Chronic Kidney Disease: A Perspective on High-Density Lipoprotein

Mohammad Abdullah Al Zubair Naim1, Keiichi Sumida1, Elani Streja2

  • 1Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.

Drugs
|January 13, 2026
PubMed

Insights

Chronic kidney disease (CKD) impairs high-density lipoprotein cholesterol (HDL-C) function, increasing cardiovascular disease (CVD) risk. Further research into HDL-targeted therapies is crucial for managing dyslipidemia and improving outcomes in CKD patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Biochemistry

Background:

  • Chronic kidney disease (CKD) is a significant risk factor for cardiovascular disease (CVD).
  • Dyslipidemia in CKD patients is characterized by impaired high-density lipoprotein cholesterol (HDL-C) functionality, contributing to atherosclerosis and adverse CVD outcomes.
  • Existing lipid-lowering therapies (LLTs) effective in non-CKD populations may not translate directly to CKD due to distinct lipid profiles and limited clinical trial data.

Purpose of the Study:

  • To review the impact of CKD on HDL-C functionality.
  • To explore the evidence for various LLTs in elevating HDL-C and improving clinical outcomes in CKD patients.
  • To identify research gaps and propose future directions for HDL-targeted therapies in CKD.

Main Methods:

  • Narrative review of existing literature.
  • Discussion of HDL-C function in CKD.
  • Exploration of evidence for different LLTs, including HDL-elevating therapies.

Main Results:

  • CKD alters HDL-C's antioxidant, anti-inflammatory, and cholesterol transport capacities.
  • Current guidelines recommend statins for hyperlipidemia in non-dialysis-dependent CKD, but evidence for HDL-elevating therapies is limited.
  • Plausible mechanisms exist for HDL-elevation to improve outcomes, but require further investigation in CKD populations.

Conclusions:

  • Further investigation into HDL-targeted therapies is recommended for CKD patients.
  • Comparative effectiveness studies of HDL-elevating LLTs versus statins are needed.
  • Research should clarify whether HDL-C elevation directly mediates improved clinical outcomes in CKD.

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