Treatment options for dyslipidemia in chronic kidney disease and for protection from contrast-induced nephropathy

Abstract

Chronic kidney disease (CKD) is highly prevalent worldwide and represents a major cardiovascular risk factor. Dyslipidemia is present in most patients with CKD and further worsens CKD, creating a vicious cycle. The treatment of CKD-related dyslipidemia has been a controversial topic. The use of statins is recommended in all stages of CKD, but it appears to reduce cardiovascular and renal events only in the early CKD stages, up to stage 3. The use of atorvastatin has proven very beneficial; thus, the earliest we start statin treatment, the better for the patient. Atorvastatin and pitavastatin do not need dose adjustments at any level of renal function. Fibrates can be administered in mixed hyperlipidemia, combined with statins in early CKD stages. Omega-3 fatty acids are useful for treating hypertriglyceridemia in CKD. Antibodies against proprotein convertase subtilisin/kexin type 9 hold promise for a better control of dyslipidemia and a greater reduction of cardiovascular risk.

Keywords:

• cardiovascular disease
• chronic kidney disease
• dyslipidemia
• fibrates
• proprotein convertase subtilisin/kexin type 9 antibodies
• statins

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Chronic kidney disease (CKD) is a highly significant cardiovascular risk factor.

• Dyslipidemia is prevalent in CKD and is closely related to cardiovascular morbidity and mortality.

• Statins are the cornerstone of dyslipidemia treatment in CKD.

• Early statin treatment is associated with substantial clinical benefits from the heart and the kidneys.

• At stage 4 or 5 of CKD, statin treatment has little or no effect on CVD events.

• Fibrates, at early stages, and omega-3 polyunsaturated fatty acids can be co-administered with statins in patients with CKD and mixed dyslipidemia.

• The future belongs to antibodies against proprotein convertase subtilisin/kexin type 9.