title: Lipid-Lowering Therapy in CKD: Should We Use It and in Which Patients.
abstract: BACKGROUND
  Chronic kidney disease is associated with a 15-fold increase in the risk of death and a 30-fold increase in the risk of cardiovascular events even prior to dialysis initiation, and this situation remains unchanged following the initiation of the dialysis procedure. Lipoprotein structure and function, especially the anti-oxidative properties of high-density lipoprotein, are altered. In this study, the effectiveness of lipid-lowering therapy on mortality and cardiovascular outcomes is explored.
  
  
  CONCLUSIONS
  Mortality is inversely associated with the cholesterol level. The degree of inflammation and wasting is a stronger predictor of mortality than are cholesterol levels. Treatment with statins reduces the risk of death and cardiovascular outcomes among patients not yet requiring renal replacement therapy, but is not effective once dialysis is initiated, most likely because other processes, such as inflammation, not affected by lipid-lowering therapy, dominate in the causal pathway leading to adverse outcomes. Fenofibrate is also useful in reducing cardiovascular outcomes and the progression of renal disease among patients with type 2 diabetes not yet requiring dialysis. While the lipid-lowering therapy is effective in patients with the nephrotic syndrome, no long-term outcome studies regarding hard outcomes are available.
  
  
  CONCLUSIONS
  The great increase in cardiovascular outcomes in patients with kidney disease is likely due to a consequence of properties that are unresponsive to the lipid-lowering therapy, most likely inflammation. The lipid-lowering therapy is useful in patients who are not yet in need of dialysis but does not reduce mortality in dialysis patients.
authors.affiliation: Department of Medicine, Division of Nephrology, University of California Davis, Davis, CA, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Kaysen
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control; D011345:Fenofibrate / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy* / Q000401:mortality
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D011345:Fenofibrate