Dyslipidaemia in Kidney Disease

Abstract

There is a graded inverse relationship between glomerular filtration rate and cardiovascular disease. This relationship is present even with minor levels of kidney dysfunction and is highest in patients with end-stage kidney disease (ESKD) requiring dialysis therapy. In general terms, kidney dysfunction changes the level, composition, and quality of circulating lipids in favour of a more atherogenic profile. In general, patients with advanced chronic kidney disease (CKD) and ESKD characteristically have hypertriglyceridemia, low high-density lipoprotein-cholesterol levels, and normal or low-density lipoprotein-cholesterol (LDL-cholesterol) levels. In the general population, there is a clear positive relationship between LDL-cholesterol concentrations and atherosclerotic vascular events. Similarly, there is a strong positive relationship with LDL-cholesterol lowering with statin therapy and a reduction in cardiovascular events. Similar relationships exist in patients with mild CKD. However, the relationship loses strength with reducing levels of kidney function with no evidence of benefit of lowering LDL-cholesterol with statins in patients in dialysis. Several guidelines have been produced addressing lipid management in patients with CKD/ESKD. In general they are consistent in advocating treatment with statin or statin/ezetimibe combination in patients with CKD and advising not initiating treatment in patients with ESKD on dialysis.