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Management of Dyslipidemia in Chronic Kidney Disease

  • Review
  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Chronic kidney disease (CKD) ranks among the top five causes of global mortality, affecting 1 in 7 US adults (approximately 35.5 million people) in the United States. Cardiovascular disease (CVD) remains the leading cause of death in CKD patients. Atherogenic dyslipidemia, characterized by low HDL-C, high triglyceride-rich lipoproteins, and small-dense LDL particles, is common in CKD. Statins remain the foundation of lipid-lowering therapy in patients with CKD. Several other non-statin options currently exist to achieve non-HDL cholesterol targets, and most major societal guidelines emphasize the uses of these agents in their recommendations. These non-statin options include ezetimibe, bempedoic acid, PCSK9 inhibitors, fenofibrate, and omega-3 fatty acids. Several other classes of agents are in development. This review will summarize the salient considerations in managing lipid disorders in CKD patients.

Recent Findings

Despite mounting evidence suggesting that CKD is an independent risk factor for cardiovascular morbidity and mortality, the rates of utilization of lipid-lowering therapy in CKD patients remain sub-optimal. Concerns about the safety and efficacy of statins as a therapeutic option in CKD is a significant barrier for optimal lipid management in this population. Most guidelines recommend treating dyslipidemia with lipid-lowering therapy to target an LDL-C level less than 100 mg/dL for most CKD patients in the absence of other ASCVD (Atherosclerotic cardiovascular disease) risk enhancers. In the presence of other risk factors like diabetes, hypertension, and ASCVD, targeting an LDL-C level of 70 mg/dL or even lower, depending on the risk factor profile, is recommended.

Summary

ASCVD due to CKD is a significant cause of mortality and morbidity. Management of dyslipidemias in the CKD population is crucial to achieve good CV outcomes. Multiple therapeutic options are available to optimize the lipoprotein profile in CKD patients. The benefit of initiating lipid-lowering therapy in ESRD (end-stage renal disease) patients in the absence of clinical ASCVD is, however, debatable, and more studies are needed on this population.

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Data Availability

No datasets were generated or analysed during the current study.

Abbreviations

Apo:

Apolipoprotein

ASCVD:

Atherosclerotic cardiovascular disease

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

CETP:

Cholesteryl ester transfer protein

CKD:

Chronic kidney disease

CVD:

Cardiovascular disease

DHA:

Docosahexaenoic acid

ESRD:

End-stage renal disease

EPA:

Eicosapentaenoic acid

FAs:

Fatty acids

GBD:

Global Burden of Disease

HR:

Hazard ratio

HDL:

High-density lipoprotein

LCAT:

Lecithin–cholesterol acyltransferase

LDL-C:

Low-density lipoprotein cholesterol

Lp (a):

Lipoprotein (a)

MACE:

Major adverse cardiovascular events

PCI:

Percutaneous coronary intervention

PCSK9:

Proprotein convertase subtilisin/kexin type 9

RCT:

Randomized controlled trial

TG:

Triglyceride

USRDS:

US Renal Data System

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA

    Deepak Vedamurthy, Usman Sagheer, Akruti Patel & Gurnoor Singh

  2. Division of Cardiovascular Medicine Vice Chair, Department of Medicine Professor of Medicine & Radiology & Endowed Chair in Cardiovascular Innovations Director of Advanced Cardiac Imaging, Lipid Clinic & Infiltrative Heart Disease Program, Rudd Heart & Lung Center, University of Louisville School of Medicine, 201 Abraham Flexner Way, Suite 600, Louisville, KY, 40202, USA

    Dinesh Kalra

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Authors D.V. and U.S. wrote the main manuscript. G.S. prepared the figures and edited the manuscript. D.K. conceived the project and edited the manuscript. All authors reviewed the manuscript.

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