Lipid management in patients with chronic kidney disease

Abstract

Glomerular filtration rate is inversely associated with cardiovascular disease independent of conventional risk factors. An increased risk of cardiovascular disease is present even at minor levels of renal impairment and the risk is highest in patients with endstage 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 or ESRD have a characteristic lipid pattern of hypertriglyceridemia and low HDL-cholesterol levels but normal LDL-cholesterol levels. In the general population, a clear relationship exists between LDL-cholesterol, coronary heart disease and ischaemic stroke. However, in patients with ESRD, LDL-cholesterol seems to show a negative association [Au: 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 chronic kidney disease and in kidney transplant recipient but is not beneficial in patients requiring dialysis. [Au: I've moved the description of the content of your Review to the end of the introduction as per our journal style. To fully reflect the content of your article, please finish off the abstrace with a couple of sentences relating to novel lipid-lowering therapies and the need for reconsideration of the KDIGO guidelines in the light of new data. We have a limit of 200 words for this section.] [Au: I have highlighted suggestions for glossary terms throughout your manuscript with a [G]. Please provide succinct, one-sentence definitions for these specialist terms.] [H1] Introduction Guidelines regarding the management of lipids in patients with chronic kidney disease (CKD) and especially in those with end-stage renal disease (ESRD) are inconsistent in part owing to important deficiencies in the available data. [Au: Edit OK?] In 2013 KDIGO produced a comprehensive clinical practice guideline for lipid management in CKD 1. [Au: I suggest that we cite your original Table 1 (now Table 3) in the discussion of KDIGO recommendations at the end of the review so that the table is included next to this discussion in the final layout rather than in the introduction to the Review.

Apolipoprotein B, Triglyceride-Rich Lipoproteins, and Risk of Cardiovascular Events in Persons with CKD

“…Individuals with CKD have a high prevalence of hypertriglyceridemia (19). In our study, for instance, median triglyceride concentration was 168 mg/dl, compared with a median triglyceride concentration of 106 mg/dl in the general adult United States population (20).…”

“…In particular, CKD is associated with altered metabolism of apo-CIII (21), resulting in diminished activity of lipoprotein lipase and inhibited removal of triglyceriderich lipoproteins from plasma (by blocking apos from engaging with their hepatic receptors) (22), and consequently, higher triglyceride-rich lipoprotein concentrations. In contrast, LDL cholesterol concentrations are generally not raised in CKD (19). Several novel triglyceride-rich lipoproteinlowering therapies have been developed that can reduce triglyceride levels by up to 70%, such as evinacumab, an angiopoietin-like protein 3 antibody (23), and volanesorsen, an antisense oligonucleotide targeting apo-CIII mRNA (24).…”

Circulating PCSK9 Level and Risk of Cardiovascular Events and Death in Hemodialysis Patients

“…Low-density lipoprotein (LDL) cholesterol is one of the most well-established and strongest risk factors for cardiovascular (CV) events in the general population, and it remains associated with CV events in patients with non-dialysis chronic kidney disease [3]. However, the association between higher LDL and CV risk is weaker for patients with lower renal function, and LDL cholesterol level has an inconsistent association with all-cause mortality in patients on dialysis treatment [4,5]. In addition, statin treatment to reduce LDL failed to prevent CV events in HD patients, and kidney disease: improving global outcomes (KDIGO) guidelines recommend that statins should not be initiated [6][7][8].…”

<p>Association of Lipid Parameters with the Risk of Chronic Kidney Disease: A Longitudinal Study Based on Populations in Southern China</p>

“…16 At the same time, the decline of HDL with the reverse transport of cholesterol, anti-oxidation, anti-inflammatory and anti-apoptotic effects inhibited the development of CKD. 8,17 As one of the components of metabolic syndrome, hyperlipidemia is often accompanied by hypertension, impaired glucose tolerance, obesity and other clinical manifestations. Therefore, in this study, logTG/HDL was also investigated in the subgroup of hypertension and glucose metabolism disorders, namely, obesity and hyperuricemia, regarding the risk of CKD.…”