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Lipid-lowering for people with chronic kidney disease: a narrative review

David J Tunnicliffe1,2, Rathika Krishnasamy3,4, Giovanni Fm Strippoli5

  • 1Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia david.tunnicliffe@sydney.edu.au.

Drug and Therapeutics Bulletin
|July 1, 2026
PubMed

Insights

Statins effectively lower cholesterol and reduce cardiovascular events in chronic kidney disease (CKD) patients, but not those on dialysis. Guidelines recommend individualized statin therapy for CKD adults.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Chronic kidney disease (CKD) affects 14% of adults globally, significantly increasing cardiovascular risk.
  • Dyslipidemia is prevalent in CKD, exacerbating cardiovascular risk beyond traditional factors like hypertension and diabetes.
  • The precise role of cholesterol and triglycerides in CKD progression remains unclear.

Purpose of the Study:

  • To review cholesterol-lowering therapies for individuals with CKD.
  • To summarize the efficacy and safety of statins and other lipid-modifying agents in CKD patients.
  • To discuss current guidelines and future research directions for managing dyslipidemia in CKD.

Main Methods:

  • Narrative review of existing literature on cholesterol-lowering therapies in CKD.
  • Analysis of data from randomized controlled trials (RCTs) and meta-analyses concerning statins, ezetimibe, PCSK9 inhibitors, and inclisiran.
  • Examination of current clinical practice guidelines for lipid management in CKD.

Main Results:

  • Statins, with or without ezetimibe, are the most studied treatments, reducing cardiovascular events and mortality in CKD patients not on dialysis.
  • Statins did not show a benefit in reducing cardiovascular events in patients requiring dialysis, despite similar lipid-lowering effects.
  • While statins may improve kidney function, they have not demonstrated a significant benefit in preventing kidney failure.
  • Current guidelines recommend individualized statin therapy for most CKD adults but lack specific lipid targets for treatment escalation.

Conclusions:

  • Statins are recommended for cardiovascular risk reduction in most CKD patients, with individualized treatment approaches.
  • Evidence for the benefit of newer therapies like PCSK9 inhibitors and inclisiran in CKD is limited, necessitating further research.
  • Future research should focus on defining the role of novel lipid-lowering agents in improving cardiovascular and kidney outcomes in the CKD population.

Keywords:
Cardiovascular DiseasesEvidence-Based MedicineTherapeutics

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