Lipid-lowering agents for the treatment of hyperlipidemia in patients with chronic kidney disease and end-stage renal disease on dialysis: a review

Cardiovascular disease (CVD) continues to be the leading cause of death in Western civilizations, and hyperlipidemia is a well-established independent risk factor for the development of atherosclerosis and CVD progression. Many chronic kidney disease (CKD) and dialysis patients have the traditional CVD risk factors (age, obesity, hypertension, diabetes mellitus, and hyperlipidemia); however, CKD and dialysis predispose patients to several non-traditional risk factors, including myocardial remodeling, hyperparathyroidism, malnutrition, bone and mineral disorders, anemia, albuminuria, inflammation, and endothelial dysfunction. Interestingly, as both cardiovascular morbidity and mortality increase and renal function declines, the therapeutic benefits of lipid-lowering agents decrease significantly. However, their recognized reduction in cardiovascular events and excellent tolerability contribute to the frequent use of lipid-lowering agents. Statins are the most commonly prescribed agents for the treatment of hyperlipidemia. Recent post hoc analyses of the lipid lowering in patients with CKD indicate that lowering low-density lipoprotein cholesterol may provide long-term cardiovascular protection in patients with CKD stages I-IV. However, questions remain regarding the optimal role of lipid-lowering agents for primary prevention in patients on dialysis. Statins remain the preferred first-line pharmacologic therapy, but non-statin add-on therapies can be used to decrease the overall risk of CVD in the CKD population, though evidence supporting each agent in CKD is limited. Finally, given the reduced glomerular filtration and drug clearance, healthcare providers should monitor their patients closely and adjust treatment goals and objectives according to patient factors, drug safety, efficacy, and cost.