Which CKD patients should receive pharmacological statin therapy for dyslipidemia?
The KDIGO guidelines recommend that all adults aged over 50 years with an eGFR less than 60 mL/min per 1.73 m 2 not treated with dialysis or kidney transplantation (GFR categories G3a-G5) should be treated with a statin or statin/ezetimibe combination.
This recommendation is based on the results of the SHARP trial and the fact that most patients older than 50 years with at least CKD 3a would have a greater than 10% risk of coronary heart disease (CHD) at 10 years, thus warranting statin therapy.
Therefore the level of LDL cholesterol would not be required to assess the CHD risk and initiate therapy in this population. The treatment of hypertriglyceridemia in CKD is limited by a lack of data.
A subgroup analysis of nearly 1000 men from the Veterans Affairs High-Density Lipoprotein Intervention Trial (VA-HIT) did not demonstrate a mortality benefit with lowering triglycerides in participants with CKD. Currently, due to the increased risk of drug-related adverse events, co-administration of fibrates in patients receiving statin therapy is not recommended and is contraindicated in persons with advanced CKD.
The exception to this may be the prevention of pancreatitis when levels are >500 mg/dL despite lifestyle modification therapy.
