What is the role of lipid management in CKD?
The greater the amount of proteinuria, the worse the abnormalities in the lipid panel.
Patients with proteinuria generally have elevated total cholesterol and low-density lipoprotein cholesterol, as well as low levels of high-density lipoprotein cholesterol. Patients with diabetes may have, in addition, elevated triglyceride levels.
Lipid-lowering therapies are as effective in lowering cholesterol levels in patients with CKD as in the general population.
No dosage adjustments are required for statins, bile acid sequestrants, niacin, or ezetemibe. Fibrates do require a dosage adjustment for kidney function. However, the magnitude of effect of these drugs on reducing cardiovascular disease may not be as large as that seen in the general population.
Two large, randomized, controlled trials have been unable to show any significant reduction in fatal and/or nonfatal cardiovascular events in dialysis patients. The Study of Heart and Renal Protection (SHARP) study demonstrated that treatment of patients with CKD with simvastatin/ezetimibe was associated with a significant reduction in cardiovascular events; however, there was no effect on cardiovascular or all-cause mortality.
The results were the same whether or not the patients were undergoing dialysis. These data indicate that the benefit with lipid lowering in patients with CKD may not be as large as that seen in patients without kidney disease.