Management of dyslipidaemia in patients with chronic kidney disease: a position paper endorsed by the Italian Society of Nephrology

Pontremoli, Roberto; Bellizzi, Vincenzo; Bianchi, Stefano; Bigazzi, Roberto; Cernaro, Valeria; Vecchio, Lucia Del; Nicola, Luca De; Leoncini, Giovanna; Mallamaci, Francesca; Zoccali, Carmine; Buemi, Michele

doi:10.1007/s40620-020-00707-2

Cited by 12 publications

(4 citation statements)

References 137 publications

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“…In addition, these data confirm that high LDL worsens the outcomes of patients with CKD, as highlighted by previous literature mainly focused on the negative cardiovascular effects of cholesterol. 20 On the other hand, the role of inflammatory pathways in the onset of depressive symptoms in subjects with CKD is confirmed by the contemporary increase of ARA/LA ratio in more severely depressed subjects. ARA/LA is a proinflammatory marker that has been associated with increased cardiovascular risk in other studies.…”

Section: Discussionmentioning

confidence: 95%

Associations Between Cholesterol and Fatty Acid Profile on the Severity of Depression in Older Persons With Nondialysis Chronic Kidney Disease

Buoli

Caldiroli

Guenzani

et al. 2021

Journal of Renal Nutrition

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Depressive symptoms worsen the outcomes of patients affected by chronic kidney disease (CKD). The purpose of the present article is to study the association between serum lipid profile and the severity of depression in patients with CKD. We evaluated 132 older subjects with advanced CKD (stage 3-5, not receiving dialysis) in regular follow-up in a nephrology clinic. Blood samples were collected after an overnight fast. All patients were evaluated with the Geriatric Depression Scale which is comprised of 30 items that assess the severity of depressive symptoms. A backward multivariate regression analysis was performed to study the association between lipid profile and severity of depression. Low-density lipoprotein levels (b 5 2.77, P 5 .008) and arachidonic acid/linoleic acid ratio (b 5 2.51, P 5 .015) were found to be significantly associated with severity of depressive symptoms. Change in dietary habits or the use of hypocholesterolemic drugs could potentially prevent depressive symptoms and ameliorate outcome of patients affected by CKD. Data from prospective studies are needed to confirm these preliminary results.

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Section: Discussionmentioning

confidence: 95%

Associations Between Cholesterol and Fatty Acid Profile on the Severity of Depression in Older Persons With Nondialysis Chronic Kidney Disease

Buoli

Caldiroli

Guenzani

et al. 2021

Journal of Renal Nutrition

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“…These results are supported by other studies. For example, Pontremoli et al highlighted that reducing LDL-C in patients with Chronic Kidney Disease (CKD) can be beneficial in preventing major atherosclerotic events 74 .…”

Section: Methodsmentioning

confidence: 99%

A framework for detecting causal effects of risk factors at an individual level based on principles of Mendelian randomization: Applications to modelling individualized effects of lipids on coronary artery disease

Shi,

Xiang,

et al. 2024

Preprint

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Mendelian Randomization (MR), a method that employs genetic variants as instruments for causal inference, has gained popularity in assessing the causal effects of risk factors. However, almost all MR studies primarily concentrate on the population's average causal effects. With the advent of precision medicine, the individualized treatment effect (ITE) is often of greater interest. For instance, certain risk factors may pose a higher risk to some individuals compared to others, and the benefits of a treatment may vary among individuals. This highlights the importance of considering individual differences in risk and treatment response. We propose a new framework that expands the concept of MR to investigate individualized causal effects. We presented several approaches for estimating Individualized Treatment Effects (ITEs) within this MR framework, primarily grounded on the principles of the "R-learner". To evaluate the existence of causal effect heterogeneity, we proposed two permutation testing methods. We employed Polygenic Risk Scores (PRS) as the instrument and demonstrated that the removal of potentially pleiotropic SNPs could enhance the accuracy of ITE estimates. The validity of our approach was substantiated through comprehensive simulations. We applied our framework to study the individualized causal effect of various lipid traits, including Low-Density Lipoprotein Cholesterol (LDL-C), High-Density Lipoprotein Cholesterol (HDL-C), Triglycerides (TG), and Total Cholesterol (TC), on the risk of Coronary Artery Disease (CAD) using data from the UK Biobank. Our findings indicate that an elevated level of LDL-C is causally linked to increased CAD risks, with the effect demonstrating significant heterogeneity. Similar results were observed for TC. We also revealed clinical factors contributing to the heterogeneity of ITE based on Shapley value analysis. Furthermore, we identified clinical factors contributing to the heterogeneity of ITEs through Shapley value analysis. This underscores the importance of individualized treatment plans in managing CAD risks.

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“…Fibrates should rarely be considered for treatment in this population [58]. No effect on CKD progression has been observed by the use of PCSK-9 inhibitors [59].…”

Section: Lipidsmentioning

confidence: 99%

Management of Kidney Failure in Patients with Diabetes Mellitus: What Are the Best Options?

Fuster

Craver

Pino

et al. 2021

JCM

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Diabetic kidney disease (DKD) is the most frequent cause of kidney failure (KF). There are large variations in the incidence rates of kidney replacement therapy (KRT). Late referral to nephrology services has been associated with an increased risk of adverse outcomes. In many countries, when patients reach severely reduced glomerular filtration rate (GFR), they are managed by multidisciplinary teams led by nephrologists. In these clinics, efforts will continue to halt chronic kidney disease (CKD) progression and to prevent cardiovascular mortality and morbidity. In patients with diabetes and severely reduced GFR and KF, treating hyperglycemia is a challenge, since some drugs are contraindicated and most of them require dose adjustments. Even more, a decision-making process will help in deciding whether the patient would prefer comprehensive conservative care or KRT. On many occasions, this decision will be conditioned by diabetes mellitus itself. Effective education should cover the necessary information for the patient and family to answer these questions: 1. Should I go for KRT or not? 2. If the answer is KRT, dialysis and/or transplantation? 3. Dialysis at home or in center? 4. If dialysis at home, peritoneal dialysis or home hemodialysis? 5. If transplantation is desired, discuss the options of whether the donation would be from a living or deceased donor. This review addresses the determinant factors with an impact on DKD, aiming to shed light on the specific needs that arise in the management and recommendations on how to achieve a comprehensive approach to the diabetic patient with chronic kidney disease.

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Management of dyslipidaemia in patients with chronic kidney disease: a position paper endorsed by the Italian Society of Nephrology

Cited by 12 publications

References 137 publications

Associations Between Cholesterol and Fatty Acid Profile on the Severity of Depression in Older Persons With Nondialysis Chronic Kidney Disease

Associations Between Cholesterol and Fatty Acid Profile on the Severity of Depression in Older Persons With Nondialysis Chronic Kidney Disease

A framework for detecting causal effects of risk factors at an individual level based on principles of Mendelian randomization: Applications to modelling individualized effects of lipids on coronary artery disease

Management of Kidney Failure in Patients with Diabetes Mellitus: What Are the Best Options?

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