All stages of renal disease are assocated with increased cardiovascular risk. Isolated microalbuminuria increases the risk of a heart attack or stroke by over 60%, while dialysis increases the resi of death from cardiac disease by up to 100 fold.
Hyperlipidaemia is common in patients with renal disease. Sub-groupo analysis of the big statin trials has demonstrated a risk reduction for cardiovascular events in CKD stage 3 patients treated with statins, comparable to non CKD patients. However, intervention studies in dialysis patients have failed to show improved outcomes. There is also limited evidence that lipid lowering may slow the rate of progression of renal disease.
Guidelines for Treatment
In the absence of high quality evidence we recommend the following:
- All patients with CKD should have lipids checked annually
- If random total cholesterol >5.0 mmol/L then all patients should receive lifestyle advice (addressing all risk factors including diet)
The Joint British Societies Guidelines on prevention of coronary heart disease recommend initiating a statin in patients with established vascular disease and high risk individuals without clinically overt vascular disease at a serum total cholesterol ≥ 5.0mmol/l (LDL cholesterol less than 3.0 mmol/l), and aspirin treatment if BP >150/90.
Pending the outcome of the SHARP trial, statin therapy should be considered in all patients with Stage 1-3 chronic kidney disease with a predicted 10 year cardiovascular risk of 20% or higher, irrespective of baseline lipid parameters.
Nephrotic patients have hypercholesterolaemia. If they do not respond promptly to treatment of the nephrotic syndrome, they should be started on lipid lowering therapy.
A statin should normally be the first line. In combined hyperlipidaemia atorvastatin may have improved efficacy. Watch for myositis and rhabdomyolysis in patients with CRF.
Acknowledgements: Caroline Whitworth was the main author for this page. The last modified date is shown in the footer.