title: Etiology and management of dyslipidemia in children with chronic kidney disease and end-stage renal disease.
abstract: Lipids are essential components of cell membranes, contributing to cell fuel, myelin formation, subcellular organelle function, and steroid hormone synthesis. Children with chronic kidney disease (CKD) and end-stage renal disease (ESRD) exhibit various co-morbidities, including dyslipidemia. The prevalence of dyslipidemias in children with CKD and ESRD is high, being present in 39-65% of patients. Elevated lipid levels in children without renal disease are a risk factor for cardiovascular disease (CVD), while the risk for CVD in pediatric CKD/ESRD is unclear. The pathogenesis of dyslipidemia in CKD features various factors, including increased levels of triglycerides, triglyceride-rich lipoproteins, apolipoprotein C3 (ApoC-III), decreased levels of cholesterylester transfer protein and high-density lipoproteins, and aberrations in serum very low-density and intermediate-density lipoproteins. If initial risk assessment indicates that a child with advanced CKD has 2 or more co-morbidities for CVD, first-line treatment should consist of non-pharmacologic management such as therapeutic lifestyle changes and dietary counseling. Pharmacologic treatment of dyslipidemia may reduce the incidence of CVD in children with CKD/ESRD, but randomized trials are lacking. Statins are the only class of lipid-lowering drugs currently approved by the U.S. Food and Drug Administration (FDA) for use in the pediatric population. FDA-approved pediatric labeling for these drugs is based on results from placebo-controlled trial results, showing 30-50% reductions in baseline low-density lipoprotein cholesterol. Although statins are generally well tolerated in adults, a spectrum of adverse events has been reported with their use in both the clinical trial and post-marketing settings.
authors: Center for Drug Evaluation and Research Office of New Drugs Division of Nonprescription Regulation Development, United States Food and Drug Administration, Silver Spring, MD, USA.
authors: Mona
authors: M
authors: Khurana
authors: Center for Devices and Radiological Health, Division of Reproductive, Gastro-Renal and Urological Devices, Renal Devices Branch, United States Food and Drug Administration, 10903 New Hampshire Avenue Building 66-G252, Silver Spring, MD, 20993, USA. dsilverstein2001@yahoo.com.
authors: Douglas M
authors: DM
authors: Silverstein
mesh_terms: D000328:Adult; D015897:Comorbidity; D004032:Diet; D050171:Dyslipidemias / Q000178:diet therapy / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications*; D008019:Life Style; D008055:Lipids / Q000097:blood; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids
keywords: Adverse events; Cardiovascular disease; Chronic kidney disease; Dietary counseling; Dyslipidemia; Lifestyle change; Statin therapy