New Guidelines For Lipid Management in the Chronic Kidney Disease Patient

Adults with newly diagnosed CKD should be evaluated with a lipid profile. Most patients do not require follow-up measurements of lipid levels, with additional assessments performed only if they will alter management. Adults 50 and older who have an eGFR under 60 mL/min/1.73 m2 but who do not require chronic dialysis and have not had a kidney transplant should be treated with a statin with or without ezetimibe. Treatment with a statin is recommended in adults 50 and older with CKD who have an eGFR of 60 mL/min/1.73 m2 or higher. For adults younger than 50 who have CKD but who are not on chronic dialysis and have not had a kidney transplant, a statin should be used in patients with at least one of the following conditions: known coronary disease, diabetes, prior ischemic stroke, or an estimated 10-year risk of coronary death or myocardial infarction exceeding 10%. It is suggested that statins with or without ezetimibe should not be started in dialysis-dependent patients with CKD. Patients with CKD who are already taking a statin with or without ezetimibe and who need to start dialysis should continue their cholesterol-lowering treatment. Patients who have undergone a kidney transplant should use a statin. The authors underscored patient preference in the decision about starting a statin throughout the guidance, however, similar to the patient-physician risk discussion pushed in the AHA/ACC guidelines. The KDIGO guidelines provide a table to help physicians select the appropriate statin and dose once the decision has been made to initiate treatment. "Given the potential for toxicity with higher doses of statins and the relative lack of data evaluating the safety of these regimens in advanced CKD, the work group suggests that prescription of statins in persons with eGFR less than 60 mL/min/1.73 m2 or renal replacement therapy should be based on regimens and doses that have been shown to be beneficial in randomized trials done specifically in this population," Tonelli and Wanner wrote.