Why the study?
Statin efficacy is debatable in end-stage renal disease under renal replacement therapy, motivating novel treatment strategies for the altered dyslipidemia pattern in CKD.
This review highlights that while statins remain the standard of care for dyslipidemia in CKD, novel therapies targeting PCSK9, Lp(a), and hypertriglyceridemia are emerging to address residual cardiovascular risk.
Supports statin prioritization in non-dialysis CKD; leaves open role of PCSK9/Lp(a) agents for residual risk in ESRD.
In this review article, we first provide the latest pathophysiologic evidence regarding the altered dyslipidemia pattern in CKD, followed by its contemporary management according to the latest guidelines. Moreover, we present the current progress regarding the emerging therapeutic strategies. Key Messages: The presence of renal impairment leads to alterations in cholesterol structure, metabolism, and reverse transport paired with increased oxidative stress. Statins remain the cornerstone of dyslipidemia management in patients with kidney dysfunction who are at risk for cardiovascular events. However, their efficacy is debatable in end-stage renal disease under renal replacement therapy. Therefore, novel treatment approaches aiming at hypertriglyceridemia, proprotein convertase subtilisin/kexin type 9, and lipoprotein(a) are under rigorous investigation while the research of gut microbiome might provide additional mechanistic and therapeutic insight.
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Theofilis et al. (2021) studied this question.
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