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Indications for statins in nondialysis chronic kidney disease

Authors
Alfred K Cheung, MD
Gerald B Appel, MD
Section Editor
Gary C Curhan, MD, ScD
Deputy Editor
Alice M Sheridan, MD

INTRODUCTION

Lipid abnormalities are common in patients with all stages of chronic kidney disease (CKD) [1-7]. Hypertriglyceridemia is the primary lipid abnormality among CKD patients, although abnormalities in cholesterol and apolipoproteins also occur [8].

This topic reviews the pathogenesis, epidemiology, and treatment of lipid abnormalities in nondialysis CKD patients. The pathogenesis and significance of lipid abnormalities in nephrotic syndrome and following kidney transplantation, the association between CKD and coronary heart disease (CHD), and the management of lipids in patients with CKD who require dialysis are discussed separately. (See "Lipid abnormalities in nephrotic syndrome" and "Lipid abnormalities after renal transplantation" and "Chronic kidney disease and coronary heart disease" and "Secondary prevention of cardiovascular disease in end-stage renal disease (dialysis)", section on 'Lipid modification'.)

COMMON LIPID ABNORMALITIES

As in non-CKD patients, lipid abnormalities may involve triglycerides, cholesterol, and apolipoproteins.

Triglycerides — Hypertriglyceridemia is the primary lipid abnormality among CKD patients. Approximately 40 to 50 percent of CKD patients have fasting triglyceride levels >200 mg/dL (2.26 mmol/L). Hypertriglyceridemia among CKD patients is caused by defective clearance and reductions in the activity of lipoprotein lipase and hepatic triglyceride lipase [3,4,9]. Defective clearance results from alterations in the composition of circulating triglycerides, which become enriched with lipase-inhibiting apolipoprotein C-III, and reductions in the activity of lipoprotein lipase and hepatic triglyceride lipase [3,4,9]. Other potential contributors to decreased triglyceride clearance include secondary hyperparathyroidism [10-12] and retention of circulating inhibitors of lipoprotein lipase, such as pre-beta-high-density lipoprotein (HDL) [13]. Pre-beta-HDL is a form of apolipoprotein A-I found in the non-lipoprotein fraction of normal plasma.

Cholesterol — Approximately 20 to 30 percent of CKD patients have total serum cholesterol levels >240 mg/dL (6.2 mmol/L) [1-7]. In other CKD patients, the serum cholesterol concentration is normal or low [8].

           

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Literature review current through: Jul 2016. | This topic last updated: Jul 27, 2016.
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