Serum lipids and prevention of atherosclerotic cardiovascular events in hemodialysis patients.
This article reviews the relationship between serum lipids and cardiovascular disease (CVD) in hemodialysis patients. Epidemiologic studies showed a cholesterol paradox in hemodialysis patients, but it can be solved by taking protein-energy wasting and inflammation into consideration. Wasting and inflammation are the risk factors of fatality after incident CVD. Randomized controlled trials showed neutral effects of statins and statin-ezetimibe combination on CVD outcomes in dialysis patients. Current guidelines in Japan recommend that low-density lipoprotein cholesterol (LDL-C) be <120 mg/dL, or non-high-density lipoprotein cholesterol (non-HDL-C) be <150 mg/dL as an alternative target in patients with chronic kidney disease (CKD), whereas Kidney Disease: Improving Global Outcome (KDIGO) guidelines do not recommend any target lipid levels. In addition to "treat to target" and "fire and forget" guidelines, it is possible to recommend that lipid-lowering medication be initiated in certain subgroups of CKD patients. New directions of lipid research in CKD include cholesterol metabolism markers, omega-3 polyunsaturated fatty acids, and modifications of lipoproteins.
Department of Geriatrics and Vascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan, t-shoji@med.osaka-cu.ac.jp.
Tetsuo
T
Shoji
D044466:Asian People; D050197:Atherosclerosis / Q000517:prevention & control*; D001384:Azetidines / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D002784:Cholesterol / Q000097:blood; D000069438:Ezetimibe; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007249:Inflammation / Q000097:blood; D008055:Lipids / Q000097:blood*; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000150:complications*
D001384:Azetidines; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids; D002784:Cholesterol; D000069438:Ezetimibe