Effects of lipid-lowering therapy on reduction of cardiovascular events in patients with end-stage renal disease requiring hemodialysis

Pharmacotherapy
Joel C Marrs, Joseph J Saseen

Abstract

In the general population, dyslipidemia is an established independent risk factor for cardiovascular disease. In patients with end-stage renal disease (ESRD), comorbid cardiovascular disease is present at alarming rates, and those who require hemodialysis and have cardiovascular disease continue to have a high mortality rate. Lipid abnormalities associated with chronic kidney disease (CKD) vary depending on the stage of disease (stages 1-5), but low-density lipoprotein cholesterol (LDL) has been established as the primary lipid treatment target. Guidelines support an LDL level of less than 100 mg/dl in patients with all stages of CKD, except when the triglyceride level is above 500 mg/dl. As patients progress to stage 5 CKD (ESRD with hemodialysis), the high triglyceride, low high-density lipoprotein cholesterol, and increased lipoprotein(a) levels of the early stages become more pronounced, with increases in small dense LDL particles; however, total cholesterol and LDL values remain normal or decrease. In patients undergoing hemodialysis, lipid abnormalities are driven by an increase in hepatic secretion and delayed catabolism of very low-density lipoproteins, as well as a reduction in lipoprotein lipase and hepatic lipase. Ep...Continue Reading

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Citations

Mar 30, 2011·European Heart Journal·Luis M Ruilope, George L Bakris
Nov 8, 2014·Seminars in Dialysis·Mitchell H Rosner, Madhukar Misra
Mar 29, 2019·European Journal of Clinical Investigation·Towe StrålbergErik Nilsson
Oct 28, 2010·Expert Opinion on Pharmacotherapy·Patrick Biggar, Markus Ketteler
Nov 20, 2020·Seminars in Dialysis·Katie E Cardone, Wendy M Parker

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