Management of Hyperglycemia, Dyslipidemia, and Albuminuria in Patients With Diabetes and CKD: A Systematic Review for a KDOQI Clinical Practice Guideline

Slinin, Yelena; Ishani, Areef; Rector, Thomas S.; Fitzgerald, Patrick; MacDonald, Roderick; Tacklind, James; Rutks, Indulis; Wilt, Timothy J

doi:10.1053/j.ajkd.2012.07.017

Cited by 87 publications

(70 citation statements)

References 43 publications

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Section: Impact Of Dyslipidemia On Cardiovascular Morbidity and Mortamentioning

confidence: 99%

“…Similarly, a Cochrane database meta-analysis demonstrated that statins reduced the relative all-cause mortality, and reduced death from CVD by 20 % in more than 18,000 patients with pre-dialysis CKD, with or without CVD [24]. However, a randomized control trial (statins versus control) showed that statins did not decrease all-cause mortality or stroke in patients with CKD due to diabetes [25].A direct benefit for statins on CVD in patients with ESRD is also unproven. In one placebo, randomized controlled trial (RCT; 4D study) of 1,255 patients (460 evaluable patients who reached the primary endpoint) with ESRD secondary to diabetes, atorvastatin had no effect on CVD events [26].…”

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confidence: 99%

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Etiology and management of dyslipidemia in children with chronic kidney disease and end-stage renal disease

Khurana

Silverstein

2015

Pediatr Nephrol

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Lipids are essential components of cell membranes, contributing to cell fuel, myelin formation, subcellular organelle function, and steroid hormone synthesis. Children with chronic kidney disease (CKD) and end-stage renal disease (ESRD) exhibit various co-morbidities, including dyslipidemia. The prevalence of dyslipidemias in children with CKD and ESRD is high, being present in 39-65 % of patients. Elevated lipid levels in children without renal disease are a risk factor for cardiovascular disease (CVD), while the risk for CVD in pediatric CKD/ESRD is unclear. The pathogenesis of dyslipidemia in CKD features various factors, including increased levels of triglycerides, triglyceride-rich lipoproteins, apolipoprotein C3 (ApoC-III), decreased levels of cholesterylester transfer protein and high-density lipoproteins, and aberrations in serum very low-density and intermediatedensity lipoproteins. If initial risk assessment indicates that a child with advanced CKD has 2 or more co-morbidities for CVD, first-line treatment should consist of nonpharmacologic management such as therapeutic lifestyle changes and dietary counseling. Pharmacologic treatment of dyslipidemia may reduce the incidence of CVD in children with CKD/ESRD, but randomized trials are lacking. Lipids are essential components of cell membranes, contributing to cell fuel, myelin formation, subcellular organelle function, and steroid hormone synthesis. Lipids are generally categorized by their density and other physical characteristics [1]. Since lipids such as cholesterol and triglycerides (TG) are insoluble in plasma, lipoproteins are required to transport all sources (e.g., diet) of lipids to areas in which the lipids can either be stored for future use or used immediately [2], although it should be noted that short-and medium-chain fatty acids also flow via the portal system as fatty acids. Specifically, low-density lipoproteins (LDL) carry the majority of cholesterol (forming LDL-C), while very low-density lipoproteins (VLDL) carry the majority of triglycerides.The broad categories of lipoproteins are chylomicrons, VLDL, LDL, and high-density lipoproteins (HDL Prevalence and sub-types of dyslipidemia in pediatric chronic kidney disease (CKD) and end-stage renal disease (ESRD)Children with CKD/ESRD exhibit various co-morbidities, including dyslipidemia. The prevalence of dyslipidemias in children with CKD and ESRD is high (39-65 %), but is significantly dependent on the cause and vintage of CKD (e.g., usually more common and severe with glomerular disease and proteinuria) and the stage of the disease [4,5]. The Chronic Kidney Disease in Children (CKiD) study included an assessment of the relationship between renal function and serum lipid levels. The most common type of dyslipidemia was hypertriglyceridemia. They found an inverse relationship between renal function (measured glomerular filtration rate, or GFR) and serum TG and total cholesterol (TC) levels; that is, as GFR declines, TG and TC levels generally increase. Conversely, there is a ...

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Section: Impact Of Dyslipidemia On Cardiovascular Morbidity and Mortamentioning

confidence: 99%

mentioning

confidence: 99%

Etiology and management of dyslipidemia in children with chronic kidney disease and end-stage renal disease

Khurana

Silverstein

2015

Pediatr Nephrol

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“…This evidence suggests that fenofibrate is effective in ameliorating diabetic nephropathy. In a metaanalysis of these two studies, the significant effect on the regression from microalbuminuria to normoalbuminuria was proved; however, progression from microalbuminuria to macroalbuminuria was not significant [31].…”

Section: Treatment Of Dyslipidemia and Diabetic Nephropathymentioning

confidence: 94%

“…The effect on renal protection was not demonstrated in the Study of Heart and Renal Protection (SHARP) which included 2,094 (33 %) patients with diabetes [34], and the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) which included 3,638 (36 %) patients with diabetes [35]. A meta-analysis also showed that regression of albuminuria [31] and changes in eGFR [36] were not observed in patients with diabetes treated with statins.…”

Section: Treatment Of Dyslipidemia and Diabetic Nephropathymentioning

confidence: 99%

Treatment and impact of dyslipidemia in diabetic nephropathy

et al. 2013

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Recent epidemiological research revealed that dyslipidemia is a risk factor for development and progression of diabetic nephropathy. Results from interventional studies revealed the possibility that antihyperlipidemic agents have a better effect on diabetic nephropathy through improvement of albuminuria and loss of renal function. In addition, dyslipidemia may be a consequence of albuminuria and renal dysfunction, thereby perpetuating kidney damage. Today, the proportion of diabetic patients receiving statins is increasing due to their beneficial effect on cardiovascular mortality. However, treatment for patients should be determined based on consideration of the risk and benefit of the treatment. More insight into the pathogenesis of diabetic nephropathy and the effects of life-style changes is required.

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“…Several meta-analyses with different selection criteria about the clinical trials of statin treatment on renal outcomes had been published [97][98][99][100].…”

Section: Statin Treatment and Renal Outcomes In Randomized Controlledmentioning

confidence: 99%

Dyslipoproteinemia and Impairment of Renal Function in Diabetic Kidney Disease: An Analysis of Animal Studies, Observational Studies, and Clinical Trials

Hung¹,

Tsai²,

Kuo³

et al. 2013

Rev Diabet Stud

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■ AbstractDyslipoproteinemia is highly prevalent in diabetes, chronic kidney disease, and diabetic kidney disease (DKD). Both diabetes and chronic kidney disease (CKD) are associated with hypertriglyceridemia, lower high-density lipoprotein, and higher small, dense low-density lipoprotein. A number of observational studies have reported that dyslipidemia may be associated with albuminuria, renal function impairment, and end-stage renal disease (ESRD) in the general population, and especially in CKD and DKD patients. Diabetic glomerulopathy and the related albuminuria are the main manifestations of DKD. Numerous animal studies support the finding that glomerular atherosclerosis is the main mechanism of glomerulosclerosis in CKD and DKD. Some randomized, controlled trials suggest the use of statins for the prevention of albuminuria and renal function impairment in CKD and DKD patients. However, a large clinical study, the Study of Heart and Renal Protection (SHARP), does not support that statins could reduce ESRD in CKD. In this article, we analyze the complex association of dyslipoproteinemia with DKD and deduce its relevance from animal studies, observational studies, and clinical trials. We show that special subgroups could benefit from the statin treatment.

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Management of Hyperglycemia, Dyslipidemia, and Albuminuria in Patients With Diabetes and CKD: A Systematic Review for a KDOQI Clinical Practice Guideline

Cited by 87 publications

References 43 publications

Etiology and management of dyslipidemia in children with chronic kidney disease and end-stage renal disease

Etiology and management of dyslipidemia in children with chronic kidney disease and end-stage renal disease

Treatment and impact of dyslipidemia in diabetic nephropathy

Dyslipoproteinemia and Impairment of Renal Function in Diabetic Kidney Disease: An Analysis of Animal Studies, Observational Studies, and Clinical Trials

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