Patients with chronic kidney disease (CKD) show a high cardiovascular morbidity and mortality. This seems to be consequence of the cardiovascular risk factor clustering in CKD patients. Non traditional risk factors such as oxidative stress and inflammation are also far more prevalent in this population than in normal subjects. Renal disease is associated with a graded increase in oxidative stress markers even in early CKD. This could be consequence of an increase in reactive oxygen species as well as a decrease in antioxidant defence. This oxidative stress can accelerate renal injury progression. Inflammatory markers such as C reactive protein and cytokines increase with renal function deterioration suggesting that CKD is a low-grade inflammatory process. In fact, inflammation facilitates renal function deterioration. Several factors can be involved in triggering the inflammatory process including oxidative stress. Statin administration is accompanied by risk reduction in all major vascular events in patients with CKD that are considered high-risk patients. These beneficial effects seem to be consequence of not only their hypolipidemic effect but especially their pleitropic actions that involve modulation of oxidative stress and inflammation.

statins have been widely investigated, and their use is usually recommended in the secondary prevention of acute coronary syndrome (ACS). To investigate the use of statins for the primary prevention of ACS, between April 2004 and February 2005 we enrolled a total of 31 end-stage renal disease patients on MHD, with neither history nor clinical and instrumental signs of earlier major adverse cardiac events (MACEs). We started each patient on atorvastatin (10 mg) daily regardless of serum low-density lipoprotein cholesterol associated with conventional pharmacologic control of blood pressure, serum glucose, and calcium-phosphate balance. During a 4-year follow-up overall 3-year actuarial survival was 67%, 3 compared with a 20-40% 5-year survival reported earlier. 4 Cardiovascular mortality was 12.9%, (4 patients). 'MACE' free' (lethal and non-lethal) 3-year actuarial survival was 53%. Treatment with statins may be considered in the primary prevention of MACEs in hemodialysis patients.