Lipid disorders in uremia and dialysis.

Treatment of cholesterol in people with advanced stage chronic kidney disease (CKD) clearly reduces cardiovascular risk; however, it does not significantly slow nephropathy progression. Moreover, cholesterol reduction does not reduce mortality in people on dialysis. In general, cholesterol reduction is very important for reducing cardiovascular risk in people with GFR values >15 ml/min who are not on dialysis. There are many reasons for the lack cardiovascular risk reduction with cholesterol lowering in dialysis patients including a defective HDL and higher than usual oxidation rates of LDL. The reviews some of the biochemistry of lipids in uremia and discusses the randomized trial data that support these statements and provides greater detail regarding use of statin in patients with stages 4 and 5 CKD. Caution should be used in dosing statins in stage 3b or higher CKD. Specifically, all statins except for atorvastatin and pravastatin need dose reductions due to safety issues. Given the more 'metabolic syndrome like' profile of lipids in stage 5 CKD adjunctive methods such as fibrates and omega-3 is discussed, however no good data are available in this group on outcomes with these agents.