Dyslipidemia in chronic kidney disease: an approach to pathogenesis and treatment.
OBJECTIVE
Cardiovascular disease (CVD) is a major cause of mortality in patients with mild to moderate chronic kidney disease (CKD) and end-stage renal disease (ESRD). Dyslipidemia has been established as a well-known traditional risk factor for CVD in the general population and it is well known that patients with CKD exhibit significant alterations in lipoprotein metabolism. In this review the pathogenesis and treatment of renal dyslipidemia are discussed.


METHODS
Studies on lipid abnormalities in CKD stages 1-4, in nephrotic syndrome, and in hemodialysis and peritoneal dialysis patients are analyzed, as well as the lipid profile of kidney graft recipients. Also, the results of the effects of epoietin treatment and hypolipidemic drugs in CKD patients are reported.


RESULTS
Disturbances in lipoprotein metabolism are evident even at the early stages of CKD and usually follow a downhill course that parallels the decline of renal function. However, several intrinsic or exogenous factors can influence the phenotypic expression of these alterations. According to the literature, current evidence suggests that unlike dialysis patients, mild to moderate CKD patients could be benefit from the use of statins.


CONCLUSIONS
The use of statins is indicated in patients with mild to moderate CKD, while in subjects with ESRD lipid-lowering therapy should be individualized.
Tsimihodimos
Vasilis
V
Department of Nephrology, Medical School, University of Ioannina, Ioannina, Greece.
Dounousi
Evangelia
E
Siamopoulos
Kostas C
KC
D050171:Dyslipidemias / Q000150:complications* / Q000473:pathology* / Q000628:therapy; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000378:metabolism; D006801:Humans; D015228:Hypertriglyceridemia / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000473:pathology* / Q000628:therapy; D016030:Kidney Transplantation / Q000379:methods; D050356:Lipid Metabolism; D008055:Lipids / Q000737:chemistry; D008954:Models, Biological; D009404:Nephrotic Syndrome / Q000378:metabolism; D010530:Peritoneal Dialysis; D011994:Recombinant Proteins; D006435:Renal Dialysis; D016896:Treatment Outcome
D008055:Lipids; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa