Dyslipidemia, statins, and CKD patients’ outcomes – review of the evidence in the post-sharp era

Heymann, Eric; Kassimatis, Theodoros; Goldsmith, David

doi:10.5301/jn.5000154

Cited by 16 publications

(9 citation statements)

References 65 publications

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“…Although there is not a proven association between serum lipids and the development CVD outcomes in dialysis patients 29 , lipid measurements and treatment remains a cornerstone approach to prevent CVD even in CKD patients 24 .…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Cardiovascular Risk Factors in Hemodialysis Patients - The CORDIAL Study

Burmeister¹,

Mosmann²,

Costa³

et al. 2014

Arquivos Brasileiros De Cardiologia

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BackgroundThere are scarce epidemiological data on cardiovascular risk profile of chronic hemodialysis patients in Brazil.ObjectiveThe CORDIAL study was designed to evaluate cardiovascular risk factors and follow up a hemodialysis population in a Brazilian metropolitan city.MethodsAll patients undergoing regular hemodialysis for chronic renal failure in all fifteen nephrology centers of Porto Alegre were considered for inclusion in the baseline phase of the CORDIAL study. Clinical, laboratory and demographic data were obtained in medical records and in structured individual interviews performed in all patients by trained researchers.ResultsA total of 1215 patients were included (97.3% of all hemodialysis patients in the city of Porto Alegre). Their average age was 58.3 years old, 59.5% were male and 62.8% were white. The prevalence of cardiovascular risk factors observed was 87.5% for hypertension, 84.7% for dyslipidemia, 73.1% for sedentary lifestyle, 53.7% for tobacco use, and 35.8% for diabetes. In a multivariate adjusted analysis, we found that sedentary lifestyle (p = 0.032, PR 1.08 - 95%CI: 1.01-1.15), dyslipidemia (p = 0.019, PR 1.08 - 95%CI: 1.01-1.14), and obesity (p < 0.001, PR 1.96 - 95%CI: 1.45-2.63) were more frequent in women; and hypertension (p = 0.018, PR 1.06 - 95%CI: 1.01-1.11) and tobacco use (p = 0.006, PR 2.7 - 95%CI: 1.79-4.17) were more often found among patients under 65 years old. Sedentary lifestyle was independently associated with time in dialysis less than 12 months (p < 0.001, PR 1.23 - 95% CI: 1.14-1.33).ConclusionHemodialysis patients in this southern metropolitan Brazilian city have a high prevalence of cardiovascular risk factors resembling many northern countries.

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Section: Discussionmentioning

confidence: 99%

Prevalence of Cardiovascular Risk Factors in Hemodialysis Patients - The CORDIAL Study

Burmeister¹,

Mosmann²,

Costa³

et al. 2014

Arquivos Brasileiros De Cardiologia

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“…There has been a suggestion that statins might have been associated with decreased decline in renal function [42] . However, not only majority of data is from secondary analysis; the results have been contradictory as well [43] . As stated above, SHARP trial (only randomized trial in this population) did not show any effect of stain on renal progression.…”

Section: Ckd Patients On Dialysismentioning

confidence: 99%

Lipid abnormalities in kidney disease and management strategies

Pandya

Rao

Chaudhary

2015

WJN

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lipoprotein and low/dysfunctional low high-density) represents one of the modifiable risk factors. Renal failure patients have unique lipid abnormalities which not only have complex role in pathogenesis of CVD but also cause relative resistance to usual interventions. Most of the randomized trials have been in hemodialysis population and data from CKD non-dialysis, peritoneal dialysis and renal transplant populations is extremely limited. Compared to general population, evidence of mortality benefit of lipid lowering medications in CKD population is scarce. Future research should be directed towards establishing long term benefits and side effects of lipid lowering medications, through randomized trials, in CKD population. Core tip: Burden of cardiovascular disease and dyslipidemia continues to be high among patients with kidney diseases. Our review includes unique lipid abnormalities specifically affecting patients with kidney diseases. We have included comprehensive review of the latest evidence of the dyslipidemia treatment for each subgroup [i.e. , chronic kidney disease (CKD) not on dialysis, CKD on dialysis and Kidney transplant recipients] and current guidelines from Kidney Diseases: Improving Global Outcomes. AbstractPatients with kidney diseases continue to experience significant cardiovascular disease (CVD) morbidity and mortality. Although there are many important risk factors playing a role in the pathogenesis of CVD in chronic kidney disease (CKD) patients, dyslipidemia (elevated triglycerides, elevated oxidized low-density MINIREVIEWS 83February 6, 2015|Volume 4|Issue 1|

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“…Second, CKD is related to a large, permanent inflammatory state. This non-classic, but influential risk factor of cardiovascular diseases is perceived as the annihilator of the favorable impact of statins that is regularly observed in general population [18]. It is proven that inflammation increases the PCSK9 gene expression, disturbs cholesterol metabolism and therefore enhances the cardiovascular risk [19].…”

Section: Introductionmentioning

confidence: 99%

Elevated Circulating PCSK-9 Concentration in Renal Failure Patients is Corrected by Renal Replacement Therapy

Konarzewski¹,

Szołkiewicz

Sucajtys-Szulc

et al. 2014

Am J Nephrol

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Background: A high level of circulating PCSK9 binds to the LDL receptor, reduces its cell's surface density and leads to hypercholesterolemia. The aim of this study was to examine the circulating PCSK9 level in patients with kidney disease. Methods: Out of the patients treated in our Departments we selected: (a) 44 patients with CKD stage 3 and 4 (b) 29 patients with CKD stage 5 on maintenance hemodialysis treatment; and (c) 20 patients after successful renal transplantation. Thirty-four subjects, without CKD formed the control group. Serum biochemical parameters' concentrations were assayed by a certified laboratory. Serum PCSK9 concentration was estimated by a commercially available ELISA kit. Results: The mean serum concentration of PCSK9 in patients with kidney disease was higher than in the control group (238.7 ± 64.5 vs. 536.7 ± 190.4; p < 0.001). A strong negative correlation between serum PCSK9 concentration and eGFR was found (r = -0.66; p < 0.001), as well as between serum concentrations of PCSK9 and total- (r = 0.482; p < 0.05) or LDL-cholesterol (r = 0.533; p < 0.05), but exclusively in patients not receiving statins. The elevated serum concentration of PCSK9 in patients before hemodialysis session declined afterwards, reaching the values observed in patients after kidney transplantation and in the control group. Conclusion: The circulating PCSK9 concentration is increased in patients with CKD; however, this is not accompanied by hypercholesterolemia. The positive correlations between PCSK9/TCh and PCSK9/LDL-Ch have been found only in patients not treated with statins. The elevated circulating PCSK9 level is corrected by maintenance hemodialysis treatment and normalized by a successful kidney transplantation.

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Dyslipidemia, statins, and CKD patients’ outcomes – review of the evidence in the post-sharp era

Cited by 16 publications

References 65 publications

Prevalence of Cardiovascular Risk Factors in Hemodialysis Patients - The CORDIAL Study

Prevalence of Cardiovascular Risk Factors in Hemodialysis Patients - The CORDIAL Study

Lipid abnormalities in kidney disease and management strategies

Elevated Circulating PCSK-9 Concentration in Renal Failure Patients is Corrected by Renal Replacement Therapy

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