Statin treatment for dyslipidemia in chronic kidney disease and renal transplantation: a review of the evidence

Abstract

Patients with chronic kidney disease (CKD) have significantly increased risks of cardiovascular (CV) morbidity and mortality. Dyslipidemia is a common disorder in CKD patients. CKD patients have a different lipid profile with increased atherogenic lipid fractions, and serum low-density lipoprotein cholesterol (LDL-C) levels may underestimate the atherogenic effect of LDL-C in these patients. Dyslipidemia may contribute to the increased CV morbidity and mortality, and to the progression of kidney disease in CKD patients. Currently, statins are the pharmacologic intervention of first choice, if lifestyle changes fail adequately to lower LDL-C levels in the setting of normal or moderately elevated triglycerides. Statins have been extensively studied in a large variety of patient populations and have proven efficacy in the treatment of dyslipidemia, and in reducing CV mortality. Although much evidence supports the CV benefits of statins in patients with normal renal function, there are contradictory results for the beneficial effect of statin therapy on CV morbidity and mortality in CKD patients. While post hoc subgroup analyses of multiple randomized trials support statin use in early CKD patients, the only randomized trial conducted in diabetic dialysis patients found no evidence of benefit in overall mortality. Post transplant there is some definite CV benefit, albeit in a patient cohort selected to be at reduced CV risk by virtue of being eligible for organ transplant. The results from the AURORA and SHARP studies are awaited anxiously.