Nephroprotective and clinical potential of statins in dialyzed patients

Abstract

Background: The combination of increased cardiovascular mortality and vascular complications due to dyslipidaemia in chronic kidney disease (CKD) has focused attention onto the potential beneficial effects of 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoA) inhibitors (statins) on the course of CKD. Objective: To examine the use of statins in CKD. Methods: A review of relevant literature. Results/conclusion: Current evidence from clinical trials in CKD patients on maintenance dialysis is limited. Therefore, the routine use of statins in this population remains the decision of individual physicians in discussion with their patients.

Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel

“…Moreover, the presence of dyslipidemia in these patients might enhance the rate of decline in renal function and chronic kidney disease (CKD) progression, generally by raising the inflammation and the oxidative stress in the renal microenvironment [143][144][145][146]. In the post-hoc analyses of randomized controlled trials (RCTs) the benefits of statins in myocardial infarction (MI) also extend to patients with mild-to-moderate renal insufficiency [147], but these patients are more prone to CVD than progress to end-stage kidney disease [147].…”

Statins in patients with chronic kidney disease – an attempt at recommendations

“…The most common changes being lowered high density lipoprotein cholesterol (HDL-C) levels and elevated level of triglycerides (TG) 3 ; hypercholesterolemia per se might be present in around 50% of patients on dialysis 7 . Among lipid lowering drugs, statins are the most effective in improving the lipid profile and cardiovascular (CV) outcomes in patients with CKD [5][6][7][8][9][10] . However, despite several studies and meta-analyses there are still questions regarding their role in CKD.…”

Lipids, Blood Pressure, Kidney-what was New in 2012?

“…They also do not give detailed recommendations on combined therapy in lipid disorder patients, which seems to be a future method of dyslipidaemia treatment, for example in patients with chronic kidney disease (CKD). The recent Study of Heart and Renal Protection (SHARP) trial with simvastatin and ezetimibe showed 17% reduction in major atherosclerotic events and 15.3% in major vascular events in CKD [4,11,12].…”