Serum lipids and prevention of atherosclerotic cardiovascular events in hemodialysis patients.

Abstract

This article reviews the relationship between serum lipids and cardiovascular disease (CVD) in hemodialysis patients. Epidemiologic studies showed a cholesterol paradox in hemodialysis patients, but it can be solved by taking protein-energy wasting and inflammation into consideration. Wasting and inflammation are the risk factors of fatality after incident CVD. Randomized controlled trials showed neutral effects of statins and statin-ezetimibe combination on CVD outcomes in dialysis patients. Current guidelines in Japan recommend that low-density lipoprotein cholesterol (LDL-C) be <120 mg/dL, or non-high-density lipoprotein cholesterol (non-HDL-C) be <150 mg/dL as an alternative target in patients with chronic kidney disease (CKD), whereas Kidney Disease: Improving Global Outcome (KDIGO) guidelines do not recommend any target lipid levels. In addition to "treat to target" and "fire and forget" guidelines, it is possible to recommend that lipid-lowering medication be initiated in certain subgroups of CKD patients. New directions of lipid research in CKD include cholesterol metabolism markers, omega-3 polyunsaturated fatty acids, and modifications of lipoproteins.

• Authors: Tetsuo Shoji
• Journal: Clinical and experimental nephrology (Clin Exp Nephrol) Vol. 18 Issue 2 Pg. 257-60 (Apr 2014) ISSN: 1437-7799 [Electronic] Japan
• PMID: 24072417 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Azetidines
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Lipids
• Cholesterol
• Ezetimibe

Topics

• Asian People
• Atherosclerosis (prevention & control)
• Azetidines (therapeutic use)
• Cardiovascular Diseases (etiology, mortality, prevention & control)
• Cholesterol (blood)
• Ezetimibe
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Inflammation (blood)
• Lipids (blood)
• Practice Guidelines as Topic
• Renal Dialysis (adverse effects)
• Renal Insufficiency, Chronic (complications)