Lipid management in patients with chronic kidney disease

Charles J Ferro, Patrick B Mark, Mehmet Kanbay, Pantelis Sarafidis, Gunnar H Heine, Patrick Rossignol, Ziad A Massy, Francesca Mallamaci, Jose M Valdivielso, Jolanta Malyszko, Marianne C Verhaar, Robert Ekart, Raymond Vanholder, Gerard London, Alberto Ortiz, Carmine Zoccali

Research output: Contribution to journalReview articlepeer-review


An increased risk of cardiovascular disease, independent of conventional risk factors, is present even at minor levels of renal impairment and is highest in patients with end-stage renal disease (ESRD) requiring dialysis. Renal dysfunction changes the level, composition and quality of blood lipids in favour of a more atherogenic profile. Patients with advanced chronic kidney disease (CKD) or ESRD have a characteristic lipid pattern of hypertriglyceridaemia and low HDL cholesterol levels but normal LDL cholesterol levels. In the general population, a clear relationship exists between LDL cholesterol and major atherosclerotic events. However, in patients with ESRD, LDL cholesterol shows a negative association with these outcomes at below average LDL cholesterol levels and a flat or weakly positive association with mortality at higher LDL cholesterol levels. Overall, the available data suggest that lowering of LDL cholesterol is beneficial for prevention of major atherosclerotic events in patients with CKD and in kidney transplant recipients but is not beneficial in patients requiring dialysis. The 2013 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Lipid Management in CKD provides simple recommendations for the management of dyslipidaemia in patients with CKD and ESRD. However, emerging data and novel lipid-lowering therapies warrant some reappraisal of these recommendations.

Original languageEnglish
Pages (from-to)727-749
Number of pages23
JournalNature Reviews. Nephrology
Issue number12
Early online date2018
Publication statusPublished - 1 Dec 2018


  • Journal Article
  • Review
  • Glomerular Filtration Rate
  • Proprotein Convertase 9/antagonists & inhibitors
  • Fibric Acids/therapeutic use
  • Humans
  • Lipid Metabolism
  • Renal Insufficiency, Chronic/complications
  • Cholesterol Ester Transfer Proteins/antagonists & inhibitors
  • Biological Products/therapeutic use
  • Drug Discovery
  • Fatty Acids, Omega-3/therapeutic use
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
  • Dyslipidemias/blood
  • Cardiovascular Diseases/etiology
  • Practice Guidelines as Topic


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