Dyslipidemia in children with CKD: should we treat with statins?

Tullus, Kjell

doi:10.1007/s00467-011-1872-3

Cited by 9 publications

(9 citation statements)

References 44 publications

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“…However, the authors also commented on the lack of evidence currently available in the pediatric setting. This conclusion was also reached by Tullus [20], who reviewed the use of statins in chronic kidney disease and concluded that there is currently no evidence for a long-term beneficial effect in children with this condition. Another concern is that a study investigating the reported incidence of rhabdomyolysis in the USA concluded that renal dysfunction was associated with a higher risk of fatal outcomes in adult statin users [21].…”

Section: Discussionmentioning

confidence: 81%

Statin Use in Australian Children: A Retrospective Audit of Four Pediatric Hospitals

et al. 2014

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Statins were prescribed to children younger than suggested by current Australian guidelines, with atorvastatin being the preferred statin of choice. Long-term safety studies on the use of statins in children have only included FH patients so far, who are generally healthy besides their raised lipid levels. Further long-term safety studies are needed to include the more vulnerable transplant and renal patients, identified in this audit as being prescribed statins. This can help formulate guidelines for the safest possible use of this class of drugs in the pediatric setting, including the possibility of weight-based recommendations for younger children.

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Section: Discussionmentioning

confidence: 81%

Statin Use in Australian Children: A Retrospective Audit of Four Pediatric Hospitals

et al. 2014

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“…FDA-approved pediatric labeling for statins was based on results from placebo-controlled trial results showing 30-50 % reductions in baseline LDL-C regardless of the statin used. The short-term safety of statin therapy in children is based on clinical trials conducted for durations of 2 years or less [84]. These trials have reported asymptomatic elevations in liver transaminases in 1-5 % of children treated with a statin that reversed upon discontinuation of statin therapy.…”

Section: Pharmacologic Managementmentioning

confidence: 99%

“…Extrapolation of results from dyslipidemia trials conducted in the general adult population to children with CKD is not appropriate because the majority of these trials, which showed treatment benefits and prompted recommendations for more aggressive lipid reduction in moderate-to high-risk adults, were secondary prevention trials and do not apply to children and adolescents in whom primary prevention is the treatment goal [84]. Traditionally, primary prevention trials in adults have not definitively shown the benefits of dyslipidemia treatment in reducing the risk of both coronary and total mortality.…”

Section: Pharmacologic Managementmentioning

confidence: 99%

“…In addition, clinicians should be aware of several unique concerns to prescribing statin therapy in adolescents. An adolescent who begins statin therapy will receive a higher cumulative dose over the course of their lifetime than most adults, but the safety of such long-term statin exposure beginning in adolescence has not yet been established [84]. Clinical trials in adolescents have not observed adverse effects of statin therapy on growth parameters, hormone synthesis, pubertal development, myopathy, and rhabdomyolysis.…”

Section: Pharmacologic Managementmentioning

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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“…Due to the different etiology of CKD and pathogenesis of CVD in children with CKD, expert statements do not recommend wide use of statins in children with CKD [115]. Moreover, the recent meta-analyses showed that statins used longer than 1 year increase by 9 % the risk of incident diabetes and intensive treatment increases this risk by additional 12 % [116, 117].…”

Section: Pharmacological Treatment Strategiesmentioning

confidence: 99%

Metabolic syndrome in children with chronic kidney disease and after renal transplantation

Litwin

Niemirska

2013

Pediatr Nephrol

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Visceral obesity and metabolic abnormalities typical for metabolic syndrome (MS) are the new epidemic in adolescence. MS is not only the risk factor for cardiovascular disease but also for chronic kidney disease (CKD). Thus, there are some reasons to recognize MS as a new challenge for pediatric nephrologists. First, hypertensive and diabetic nephropathy, the main causes of CKD in adults, both share the same pathophysiological abnormalities associated with visceral obesity and insulin resistance and have their origins in childhood. Secondly, as the obesity epidemic also affects children with CKD, MS emerges as the risk factor for progression of CKD. Thirdly, metabolic abnormalities typical for MS may pose additional risk for cardiovascular morbidity and mortality in children with CKD. Finally, although the renal transplantation reverses uremic abnormalities it is associated with an exposure to new metabolic risk factors typical for MS and MS has been found to be the risk factor for graft loss and cardiovascular morbidity after renal transplantation. MS is the result of imbalance between dietary energy intake and expenditure inducing disproportionate fat accumulation. Thus, the best prevention and treatment of MS is physical activity and maintenance of proper relationship between lean and fat mass.

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Dyslipidemia in children with CKD: should we treat with statins?

Cited by 9 publications

References 44 publications

Statin Use in Australian Children: A Retrospective Audit of Four Pediatric Hospitals

Statin Use in Australian Children: A Retrospective Audit of Four Pediatric Hospitals

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

Metabolic syndrome in children with chronic kidney disease and after renal transplantation

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