Chronic kidney disease and statins: Improving cardiovascular outcomes
- 89 Downloads
The burden of chronic kidney disease (CKD) continues to increase worldwide. Patients with CKD are at greater risk of mortality from cardiovascular events than end-stage renal disease. This review describes the pathogenesis of dyslipidemia in CKD patients and the role of statins in reducing coronary heart disease morbidity and mortality. The major clinical trials with statins in CKD patients are reviewed along with a discussion of statin safety. Although statin dosing and safety in patients with early CKD (Stage I or II) are similar to those of the general population, dose adjustments are required in advanced CKD (Stages III–V) due to differences in statin pharmacokinetics and renal excretion. Although the use of statins to reduce cardiovascular events in patients with mild to moderate CKD is strongly supported by existing clinical trials, no clinical benefit has been demonstrated in two large clinical trials involving hemodialysis patients.
Unable to display preview. Download preview PDF.
References and Recommended Reading
- 1.Sarnak MJ, Levey AS, Schoolwerth, et al.: Kidney disease as a risk factor for development of cardiovascular disease: A statement from the American Heart Association on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 2003, 108:2154–2169.PubMedCrossRefGoogle Scholar
- 6.National Kidney Foundation: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis 2002, 39(2 Suppl 1):S1–S266.Google Scholar
- 10.Prinsen BH, De Sain-Van Der Velden MG, de Koning EJ, et al.: Hypertriglyceridemia in patients with chronic renal failure: possible mechanisms. Kidney Int Suppl 2003, S121–S124.Google Scholar
- 11.Diercks GF, Janssen WM, Van Boven AJ, et al.: Rationale, design, and baseline characteristics of a trial of prevention of cardiovascular and renal disease With fosinopril and pravastatin in nonhypertensive, nonhypercholesterolemic subjects with microalbuminuria (the Prevention of REnal and Vascular ENdstage Disease Intervention Trial [PREVEND IT]). Am J Cardiol 2000, 86:635–638.PubMedCrossRefGoogle Scholar
- 26.Koren MJ, Davidson MH: Impact of aggressive treatment with atorvastatin in renal function in managed care patients with coronary heart disease: the ALLIANCE study [abstract]. J Am Coll Cardiol 2005, 45(Suppl A):391AGoogle Scholar
- 27.K/DOQI clinical practice guidelines for managing dyslipidemia in chronic kidney disease. Am J Kidney Dis 2003, 41(Suppl 3):S1–S237.Google Scholar
- 28.National Cholesterol Education Program Expert Panel on Detection: Third report of the National Cholesterol Education Program (NCEP)Expert Panel on detection, evaluation, and treatment of High blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 2002, 106:3143–421.Google Scholar