Lipid lowering in dialysis patients with cardiovascular disease who are awaiting kidney transplantation

Abstract

Dyslipidemias are highly prevalent in chronic kidney disease, end‐stage renal disease, and kidney transplant patients. These dyslipidemias are associated with high cardiovascular risk and mortality. Many clinical trials have shown that statin therapy can significantly reduce adverse cardiovascular events in chronic kidney disease patients and kidney transplant recipients. However, three major trials did not show a benefit of statin therapy in end‐stage renal disease patients on dialysis. Major guidelines either recommend against the use of statins in patients on dialysis or provide no recommendations about statin use for this complex patient population. As a result, we suspect many patients on dialysis are not on statins, even if they have known atherosclerotic cardiovascular disease. When these patients receive kidney transplants, the risk of adverse cardiovascular events increases in the peri‐operative period. Although there are no randomized clinical trials looking at statin use in these patients, we suggest that statin use be considered in patients with a history of atherosclerotic cardiovascular disease, to potentially minimize peri‐operative cardiovascular complications. We also recommend further research to determine whether statin therapy in dialysis patients awaiting kidney transplant is associated with better survival.

New Approaches to Cardiovascular Disease and Its Management in Kidney Transplant Recipients

“…In fact, more recently, data suggest that perioperative use of statin in dialysis patients with high CVD risk can reduce cardiovascular events. 20 Postoperatively, KDIGO recommends that all KTRs should receive statins (class 2B recommendation). 54…”

“…In fact, more recently, data suggest that perioperative use of statin in dialysis patients with high CVD risk can reduce cardiovascular events. 20 Postoperatively, KDIGO recommends that all KTRs should receive statins (class 2B recommendation). 54 Although targets for total and LDL-C in KTRs are not known, peri-and postoperative statin use are associated with improved survival after kidney transplant.…”

“…Traditional cardiovascular risk factors are further classified as nonmodifiable (ie, age, gender, family history) or modifiable (as below) and have been extensively described previously. 18-23 Below, we will expand on key modifiable CVD risk factors that are of particular importance in the KTR population.…”