All stages of renal disease are associated with increased cardiovascular risk. Isolated microalbuminuria increases the risk of a heart attack or stroke by over 60%, while dialysis increases the risk of death from cardiac disease by up to 100 fold.
Hyperlipidaemia is common in patients with renal disease. Sub-group analysis of the big statin trials has demonstrated a risk reduction for cardiovascular events in CKD stage 3 patients treated with statins, comparable to non CKD patients. However, intervention studies in dialysis patients have failed to show improved outcomes. There is also limited evidence that lipid lowering may slow the rate of progression of renal disease.
KDIGO Guidelines for Lipid Lowering
In adults aged > 50 years with eGFR <60 ml/min/1.73 m2 GFR (categories G3a-G5, but not those who are receiving dialysis or have undergone renal transplantation) treatment with lipid-lowering therapy is recommended by KDIGO irrespective of baseline lipid parameters.
In adults aged > 50 years with CKD and eGFR> 60 ml/min/1.73 m2 (GFR categories G1-G2), treatment with a statin should be considered.
In adults aged 18–49 years with any stage of CKD (but not those who are receiving dialysis or have undergone renal transplantation), statin treatment is recommended in people with one or more of the following:
- Known coronary disease (myocardial infarction or coronary revascularization)
- Diabetes mellitus
- Prior ischaemic stroke
- Estimated 10-year incidence of coronary death or non-fatal myocardial infarction > 10%
In adults with end-stage renal failure who are dialysis dependent, lipid-lowering therapy should not be initiated. However, for those patients already receiving lipid-lowering therapy at the time of dialysis initiation, these agents should be continued.
In adult kidney transplant recipients, treatment with a statin is recommended.
Nephrotic patients frequently have hypercholesterolaemia. If they do not respond promptly to treatment of the nephrotic syndrome, they should be started on lipid lowering therapy.
Kidney Disease: Improving Global Outcomes (KDIGO) Lipid Work Group. KDIGO Clinical Practice Guideline for Lipid Management in Chronic Kidney Disease. Kidney inter., Suppl. 2013; 3: 259–305.
Acknowledgements: Caroline Whitworth was the main author for this page. It was updated in March 2021 by Ashley Simpson. The last modified date is shown in the footer.