Does the management of lipids affect the course of patients with progressive kidney failure?
Current treatment guidelines recommend treatment of hyperlipidemia in patients with CKD. A meta-analysis published in 2009 included 26 studies with 25,017 participants with stage 3 or stage 4 CKD.
Compared with placebo, statin therapy decreased the risk of all-cause mortality, cardiovascular death, and nonfatal cardiovascular events. There was no effect on rate of GFR decline. More evidence supporting the use of statins came from the SHARP trial (Study of Heart and Renal Protection).
This randomized controlled trial evaluated the efficacy of simvastatin plus ezetimibe compared with placebo in lowering cardiovascular morbidity in patients with CKD, approximately one-third of whom were on maintenance dialysis.
SHARP included 6247 patients with CKD who were not treated with maintenance dialysis. During a median follow-up of 4.9 years, simvastatin/ezetimibe lowered the incidence of the primary end points of coronary death, myocardial infarction, ischemic stroke, or any revascularization procedure (9.5% vs. 11.9% in the placebo group).
