title: Lipid and other management to improve arterial disease and survival in end stage renal disease.
abstract: Arterial disease is common in advancing renal failure, culminating in myocardial infarction with cardiac failure, strokes and peripheral and renal artery disease. Attention to cardiac and arterial disease may slow deterioration of renal function. Management of risk factors can reduce these sequelae. Areas covered: Modifiable risk factors for arterial disease and relevant pharmacotherapies. Expert opinion: Cardiovascular disease is the biggest killer in renal failure. Statins are viewed as essential in symptomatic coronary disease and have been shown in non-renal patients to improve survival after myocardial infarction. Cochrane recommends statins in renal failure but not in end stage renal disease or transplant patients. Large well powered clinical trials focussed specifically on renal patients failed to demonstrate cardiovascular outcome or mortality benefits of statins when compared to placebo. Other lipid lowering pharmacotherapies are weaker and adverse effects may account for the absence of net clinical benefit in non-renal patients in published clinical trials. Patients should be started on a statin after myocardial infarction, regardless of lipid levels, but the risk of adverse effects in advanced renal failure with its comorbidities predicates employing only essential doses. Optimal antihypertensive and antithrombotic pharmacotherapy are also priorities.
authors.affiliation: a School of Medicine and Pharmacology , University of Western Australia , Crawley , Australia.
authors.forename: Simon B
authors.initials: SB
authors.lastname: Dimmitt
authors.affiliation: b School of Medicine and Public Health , University of Newcastle, Callaghan , New South Wales , Australia.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Martin
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D008055:Lipids / Q000097:blood; D009203:Myocardial Infarction / Q000188:drug therapy; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids
keywords: Renal failure; diabetes mellitus; ezetimibe; fibrates; hyperlipidaemia; hypertension; smoking; statins