Results of the 4D study: ten years of follow-up?

Despite the exceedingly high cardiovascular risk in hemodialysis patients, it is uncertain whether statin regimens lead to clinical benefit in this population. KDIGO (Kidney Disease Improving Global Outcomes) guidelines summarize the evidence, stating that initiation of statin treatment is not recommended for most prevalent hemodialysis patients. Since the 4D and AURORA trials did not cover all age and risk ranges, an individualized treatment approach is accepted. Thus, patients and physicians may reasonably choose statin treatment if they are interested in an apparent, but relatively small, uncertain reduction in cardiovascular events. Since very high low-density lipoprotein cholesterol might increase the likelihood of benefit from statins in a dialysis patient, patients who meet this criterion may be more inclined to receive a statin. Other factors that might influence a patient's decision to receive statins could include more severe comorbidity or higher current pill burden-both favoring non-treatment--and recent myocardial infarction or greater life expectancy-both favoring treatment. The latter may be especially true for dialysis patients in Japan.