Dyslipidemia in chronic kidney disease

REVIEW ARTICLE Dyslipidemia in chronic kidney disease Pathogenesis and inter­vention Grzegorz Piecha1, Marcin Adamczak1, Eberhard Ritz2 1  Department...
Author: Morris Matthews
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REVIEW ARTICLE

Dyslipidemia in chronic kidney disease Pathogenesis and inter­vention Grzegorz Piecha1, Marcin Adamczak1, Eberhard Ritz2 1  Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Poland 2  Department of Internal Medicine, Division of Nephrology, Ruperto Carola University, Nierenzentrum Heidelberg, Germany

Key words

Abstract

coronary heart disease, dyslipidemia, lipoprotein(a), renal failure, statins

Dyslipidemia is a known cardiovascular risk factor in subjects without kidney disease. In patients with kidney disease, however, the relation of dyslipidemia to cardiovascular risk is confounded and the underlying pathomechanisms are complex. Statins have proven to be highly effective in patients with initial stages of chronic kidney disease (CKD). Definite evidence from prospective controlled trials in hemo­dialyzed (diabetic) patients and transplanted patients is not available. Although no significant impact on the primary composite endpoint was observed, significant effects on secondary endpoints were noted. In our opinion, in view of excessive cardiovascular risk statins should be administered in patients with advanced CKD as well.

Correspondence to: Prof. Eberhard Ritz, MD, PhD, Department of Internal Medicine, Division of Nephrology, Im Neuenheimer Feld 162, D‑69120 Heidelberg, phone: +49-622‑160‑17‑05, +49-622‑118‑99‑76, fax: +49-622‑160‑33‑02, e‑mail: prof.e.ritz@t‑online.de Received: October 29, 2008. Accepted: November 6, 2008. Conflict of inter­est: none declared. Pol Arch Med Wewn. 2009; 119 (7-8): 487-492 Copyright by Medycyna Praktyczna, Kraków 2009

In 1836, Richard Bright commented on the “mil­ ky serum” of patients with (what today would be called) end‑stage renal disease (ESRD) – almost certainly the first recognition of hyper­ lipidemia. The relation between heavy proteinu­ ria with dyslipidemia had been noted at the be­ ginning of the 20th century and indeed dyslip­ idemia in patients with nephrotic proteinuria differs in many respects from dyslipidemia in pa­ tients with chronic kidney disease (CKD) with non‑nephrotic proteinuria, i.e.