Lipid lowering in liver and chronic kidney disease.
Lipid lowering, particularly with HMG CoA reductase inhibitors ("statins"), reduces the risk of cardiovascular disease. Patients with chronic liver and kidney disease present challenges to the use of lipid medications. In the case of most liver disorders, the concern has been one of safety. There is evidence that most lipid-lowering medications can be used safely in many situations, although large outcomes trials are not available. In contrast, in chronic kidney disease, dosing of lipid medications may require substantial modification depending on creatinine clearance. There are significant alterations in lipid metabolism in chronic kidney disease with concomitant increases in cardiovascular risk. Some data are available on cardiovascular outcomes with dyslipidemia treatment in renal patients. This review will examine lipid physiology and cardiovascular risk in specific liver and kidney diseases and review the evidence for lipid lowering and the use of statin and non-statin therapies in chronic liver and kidney disease.
Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine, Campus Box 8127, 660 South Euclid, St. Louis, MO 63110, USA. Electronic address: cherrick@dom.wustl.edu.
Cynthia
C
Herrick
Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine, Campus Box 8127, 660 South Euclid, St. Louis, MO 63110, USA; Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, Campus Box 8127, 660 S. Euclid Ave, St. Louis, MO 63110, USA. Electronic address: mlitvin@dom.wustl.edu.
Marina
M
Litvin
Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine, Campus Box 8127, 660 South Euclid, St. Louis, MO 63110, USA; Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, Campus Box 8127, 660 S. Euclid Ave, St. Louis, MO 63110, USA. Electronic address: agoldber@dom.wustl.edu.
Anne Carol
AC
Goldberg
D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000097:blood / Q000209:etiology; D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008055:Lipids / Q000097:blood; D008107:Liver Diseases / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D012307:Risk Factors
D000960:Hypolipidemic Agents; D008055:Lipids
chronic kidney disease; chronic liver disease; dyslipidemia; end stage renal disease; ezetimibe; fibrates; statins