New Insights into Lipid Metabolism in Chronic Kidney Disease: What Are the Practical Implications?

The risk of cardiovascular disease increases with declining glomerular filtration rate. Hyperlipidemia and dyslipidemia, characterized by increased triglycerides and low levels of high-density lipoprotein, are both associated with cardiovascular outcome as well as the risk of progression of loss of renal function. Both hyperlipidemia and dyslipidemia respond to pharmacologic therapy, including hydroxymethylglutaryl-CoA reductase inhibitors and fibric acid derivatives, to alteration in diet as well as to extreme measures such as bariatric surgery. However, the effects of these modalities on cardiovascular or renal outcomes are dependent upon the level of renal function. There is strong evidence that patients with stages 1-3 chronic kidney disease attain benefit from lipid-lowering therapy both with reduction in cardiovascular risk and possibly reduction in the rate of decline in renal function. Among dialysis patients little risk reduction appears to be achieved by treatment of low-density lipoprotein cholesterol level. Bariatric surgery reduces hyperlipidemia in patients with chronic kidney disease, but has also been associated with subsequent rapid decline in renal function secondary to oxalate deposition.