Hypolipidemic therapy in patients with chronic kidney disease

The risk of death from cardiovascular disease is increased already in early stages of chronic kidney disease (CKD), and increases significantly

in more advanced stages. This risk is comparable to that in diabetes and pre-existing ischemic heart disease. The increased cardiovascular

risk in CKD is due to both traditional and untraditional risk factors, including dyslipidemia. Dyslipidemia is modifiable and should

be treated. Statins slow the progression of CKD and have a beneficial effect on proteinuria. Statins reduce all-cause and cardiovascular

mortality as well as the occurrence of cardiovascular events in early stages of CKD (stages 1 to 4); in stage 5D, however, they only have a

minor effect on the above-mentioned events. The benefit of statin treatment in stage 5D in terms of cardiovascular events can likely be

expected only in persons with increased LDL cholesterol. Fenofibrate favorably affects the progression of albuminuria in type 2 diabetics.

The largest reduction in cardiovascular events and cardiovascular mortality in the FIELD study with fenofibrate was achieved in diabetics

with stage 3 CKD. The dose of hypolipidemic agents (except for atorvastatin and ezetimibe) must be adjusted to the degree of impaired

renal function. Roughly 10% of the population have CKD and only a small proportion of them are aware of it. Early stages of CKD are

asymptomatic and CKD is often diagnosed incidentally on examination by a general practitioner or internist. Routine use of estimated

glomerular filtration rate (eGFR) and determination of microalbuminuria in at-risk individuals (particularly diabetic and hypertensive

patients) could identify a large number of people in the population who can benefit from hypolipidemic therapy.

Keywords: chronic kidney disease, dyslipidemia, hypolipidemic therapy, cardiovascular risk