Dyslipidemias in chronic kidney disease: Current guidelines and future perspectives

Introduction Dyslipidemia is a major problem in chronic kidney disease (CKD) and haemodialysis patients. Although there has been much progress and reduction in the prevalence of dyslipidemia after the Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel), there were few specific recommendations for the evaluation and treatment of dyslipidemias in CKD patients in these reports. Besides, the NCEP guidelines are applicable to patients with stages 1–4 CKD and not specifically concerned with stage 5 CKD and kidney transplant recipients. It is also evident that when these guidelines were published, there were no large randomized controlled trials evaluating the effects of lipid-lowering therapy in this patient group. Given the fact that patients with CKD should be considered in the highest risk group for cardiovascular disease, it was decided that specific recommendations regarding dyslipidemia should be applied to patients with CKD. Thus from the outset of Kidney Disease Outcomes Quality Initiative (K/DOQI), it was strongly agreed that the management of dyslipidemias in patients with kidney disease would be one of the most important issues. However, recent randomized controlled trials showed that dyslipidemia treatment in these patients had shown modest benefit at best with regard to cardiovascular mortality. The specific recommendations about dyslipidemias in CKD patients are reviewed along with the new studies and future perspectives. Conclusion While preparing the dyslipidemia guidelines for CKD patients, the K/ DOQI working group anticipated from the beginning that all the guidelines should be updated whenever new information becomes available. We do not know whether trial results from the general population are applicable to all patients with CKD. A new guideline incorporating the data of a recent research is necessary. Introduction The number of patients with chronic kidney disease (CKD) is increasing. Unfortunately, the survival of CKD patients remains poor. Among other factors, cardiovascular disease (CVD) is the leading cause of death in CKD patients. Both traditional and non-traditional factors play a role for increased cardiovascular mortality. Among traditional risk factors, diabetes, hypertension and dyslipidemia are the leading causes. Anaemia, inflammation, oxidative stress, disorders of calcium phosphorus metabolism, arterial stiffness and malnutrition can be stated as non-traditional risk factors1–3. Thus, it is of no question that CKD patients can be considered as high-risk patients. In previous reports such as Adult Treatment Panel (ATP) III, there was no specific interest regarding the dyslipidemia in CKD patients. Thus in response to the recommendations of the National Kidney Foundation (NKF) Task Force on CVD, the NKF Kidney Disease Outcomes Quality Initiative (K/DOQI) convened a work group to develop guidelines for the management of dyslipidemias, one of the risk factors for CVD in CKD. This critical review gives brief information about these guidelines first and the interpretation of these guidelines based on the recently conducted randomized prospective studies thereafter.