Skip to main content

Review of Current Guidelines: National Cholesterol Education Program and Kidney Disease Outcomes Quality Initiative as They Apply to CKD with Dyslipidemias

  • Chapter
  • First Online:
Dyslipidemias in Kidney Disease
  • 749 Accesses

Abstract

After the third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel, ATP III), there has been a much progress and reduction in prevalence of high blood cholesterol in the United States. However, in ATP III, without excluding or including patients with chronic kidney disease (CKD), there are few specific recommendations for the evaluation and treatment of dyslipidemias in CKD. Besides, the NCEP guidelines are applicable to patients with stages 1–4 CKD and not specifically concerned with Stage 5 CKD and kidney transplant recipients. It is also evident that when these guidelines were published, there were no large randomized controlled trials evaluating the effects of lipid-lowering therapy in this patient group. Given the recommendations of the National Kidney Foundation Task Force on Cardiovascular Disease in Chronic Renal Disease that patients with CKD should be considered in the highest risk group for cardiovascular disease, it was decided that specific recommendations should be applied to patients with CKD. Thus, from the outset of Kidney Disease Outcomes Quality Initiative (K/DOQI), it was strongly agreed that management of dyslipidemias in patients with kidney disease would be one of the most important issues. However, recent randomized controlled trials showed that dyslipidemia treatment in these patients had shown modest benefit at best with regard to cardiovascular mortality. Thus, in this chapter the specific recommendations about dyslipidemias in CKD patients are reviewed based on NCEP and KDOQI guidelines along with the new studies and future perspectives.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Afsar B, Elsurer R, Akgul A, Sezer S, Ozdemir FN. Factors related to silent myocardial damage in hemodialysis patients. Ren Fail. 2009;31(10):933–41.

    Article  PubMed  Google Scholar 

  2. Kanbay M, Afsar B, Goldsmith D, Covic A. Sudden death in hemodialysis: an update. Blood Purif. 2010;30(2):135–45.

    Article  PubMed  Google Scholar 

  3. Muntner P, He J, Astor BC, Folsom AR, Coresh J. Traditional and nontraditional risk factors predict coronary heart disease in chronic kidney disease: results from the atherosclerosis risk in communities study. J Am Soc Nephrol. 2005;16(2):529–38. Epub 2004 Dec 29.

    Article  PubMed  Google Scholar 

  4. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285:2486–97.

    Article  Google Scholar 

  5. Grundy SM, Cleeman JI, Merz CN, Brewer Jr HB, Clark LT, Hunninghake DB, et al. Coordinating Committee of the National Cholesterol Education Program. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. J Am Coll Cardiol. 2004;44(3):720–32.

    Article  PubMed  Google Scholar 

  6. American Academy of Pediatrics. National Cholesterol Education Program: report of the expert panel on blood cholesterol levels in children and adolescents. Pediatrics. 1992;89(3 Pt 2):525–84.

    Google Scholar 

  7. Kidney Disease Outcomes Quality Initiative (K/DOQI) Group. K/DOQI clinical practice guidelines for management of dyslipidemias in patients with kidney disease. Am J Kidney Dis. 2003;41(4 Suppl 3):I–IV, S1–91.

    Google Scholar 

  8. Shoji T, Masakane I, Watanabe Y, Iseki K, Tsubakihara Y. Committee of Renal Data Registry, Japanese Society for Dialysis Therapy. Elevated non-high-density lipoprotein cholesterol (non-HDL-C) predicts atherosclerotic cardiovascular events in hemodialysis patients. Clin J Am Soc Nephrol. 2011;6(5):1112–20.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Degoulet P, Legrain M, Réach I, Aimé F, Devriés C, Rojas P, et al. Mortality risk factors in patients treated by chronic hemodialysis. Report of the Diaphane collaborative study. Nephron. 1982;31(2):103–10.

    Article  CAS  PubMed  Google Scholar 

  10. Iseki K, Yamazato M, Tozawa M, Takishita S. Hypocholesterolemia is a significant predictor of death in a cohort of chronic hemodialysis patients. Kidney Int. 2002;61(5):1887–93.

    Article  PubMed  Google Scholar 

  11. Nishizawa Y, Shoji T, Ishimura E, Inaba M, Morii H. Paradox of risk factors for cardiovascular mortality in uremia: is a higher cholesterol level better for atherosclerosis in uremia? Am J Kidney Dis. 2001;38(4 Suppl 1):S4–7.

    Article  CAS  PubMed  Google Scholar 

  12. Kalantar-Zadeh K, Block G, Horwich T, Fonarow GC. Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J Am Coll Cardiol. 2004;43(8):1439–44.

    Article  PubMed  Google Scholar 

  13. Ingram AJ, Parbtani A, Churchill DN. Effects of two low-flux cellulose acetate dialysers on plasma lipids and lipoproteins—a cross-over trial. Nephrol Dial Transplant. 1998;13(6): 1452–7.

    Article  CAS  PubMed  Google Scholar 

  14. Epstein M, Vaziri ND. Statins in the management of dyslipidemia associated with chronic kidney disease. Nat Rev Nephrol. 2012;8(4):214–23. doi:10.1038/nrneph.2012.33.

    Article  CAS  PubMed  Google Scholar 

  15. Strippoli GF, Navaneethan SD, Johnson DW, Perkovic V, Pellegrini F, Nicolucci A, et al. Effects of statins in patients with chronic kidney disease: meta-analysis and meta-regression of randomised controlled trials. BMJ. 2008;336(7645):645–51. doi:10.1136/bmj.39472.580984.AE. Epub 2008 Feb 25.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Collins R, Armitage J, Parish S, Sleigh P, Peto R. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet. 2003;361(9374):2005–16.

    Article  PubMed  Google Scholar 

  17. Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ, et al.; CARDS Investigators. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004;364(9435):685–96.

    Google Scholar 

  18. Tonelli M, Keech A, Shepherd J, Sacks F, Tonkin A, Packard C, et al. Effect of pravastatin in people with diabetes and chronic kidney disease. J Am Soc Nephrol. 2005;16(12):3748–54. Epub 2005 Oct 26.

    Article  CAS  PubMed  Google Scholar 

  19. Chonchol M, Cook T, Kjekshus J, Pedersen TR, Lindenfeld J. Simvastatin for secondary prevention of all-cause mortality and major coronary events in patients with mild chronic renal insufficiency. Am J Kidney Dis. 2007;49(3):373–82.

    Article  CAS  PubMed  Google Scholar 

  20. Shepherd J, Kastelein JJ, Bittner V, Deedwania P, Breazna A, Dobson S, et al. TNT (Treating to New Targets) Investigators. Intensive lipid lowering with atorvastatin in patients with coronary heart disease and chronic kidney disease: the TNT (Treating to New Targets) study. J Am Coll Cardiol. 2008;51(15):1448–54.

    Article  CAS  PubMed  Google Scholar 

  21. Slinin Y, Ishani A, Rector T, Fitzgerald P, MacDonald R, Tacklind J, et al. Management of hyperglycemia, dyslipidemia, and albuminuria in patients with diabetes and CKD: a systematic review for a KDOQI clinical practice guideline. Am J Kidney Dis. 2012;60(5):747–69. doi:10.1053/j.ajkd.2012.07.017. Epub 2012 Sep 19.

    Article  PubMed  Google Scholar 

  22. Navaneethan SD, Pansini F, Perkovic V, Manno C, Pellegrini F, Johnson DW, et al. HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis. Cochrane Database Syst Rev. 2009;(2):CD007784. doi: 10.1002/14651858.CD007784.

  23. Kanbay M, Turgut F, Covic A, Goldsmith D. Statin treatment for dyslipidemia in chronic kidney disease and renal transplantation: a review of the evidence. J Nephrol. 2009;22(5): 598–609.

    CAS  PubMed  Google Scholar 

  24. Fabbian F, De Giorgi A, Pala M, Tiseo R, Manfredini R, Portaluppi F. Evidence-based statin prescription for cardiovascular protection in renal impairment. Clin Exp Nephrol. 2011;15(4):456–63.

    Article  CAS  PubMed  Google Scholar 

  25. Gluba A, Rysz J, Banach M. Statins in patients with chronic kidney disease: why, who and when? Expert Opin Pharmacother. 2010;11(16):2665–74.

    Article  CAS  PubMed  Google Scholar 

  26. Inoue T, Ikeda H, Nakamura T, Abe S, Taguchi I, Kikuchi M, et al. Potential benefit of statin therapy for dyslipidemia with chronic kidney disease: Fluvastatin Renal Evaluation Trial (FRET). Intern Med. 2011;50(12):1273–8. Epub 2011 Jun 15.

    Article  CAS  PubMed  Google Scholar 

  27. Tonelli M, Collins D, Robins S, Bloomfield H, Curhan GC; Veterans’ Affairs High-Density Lipoprotein Intervention Trial (VA-HIT) Investigators. Gemfibrozil for secondary prevention of cardiovascular events in mild to moderate chronic renal insufficiency. Kidney Int. 2004;66(3):1123–30.

    Google Scholar 

  28. Davis TM, Ting R, Best JD, Donoghoe MW, Drury PL, Sullivan DR, et al.; Fenofibrate Intervention and Event Lowering in Diabetes Study Investigators. Effects of fenofibrate on renal function in patients with type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Diabetologia. 2011;54(2):280–90. doi: 10.1007/s00125-010-1951-1. Epub 2010 Nov 4.

    Google Scholar 

  29. Wanner C, Krane V, März W, Olschewski M, Mann JF, Ruf G, et al. German Diabetes and Dialysis Study Investigators. Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med. 2005;353(3):238–48.

    Article  CAS  PubMed  Google Scholar 

  30. März W, Genser B, Drechsler C, Krane V, Grammer TB, Ritz E, et al.; German Diabetes and Dialysis Study Investigators. Atorvastatin and low-density lipoprotein cholesterol in type 2 diabetes mellitus patients on hemodialysis. Clin J Am Soc Nephrol. 2011;6(6):1316–25. doi: 10.2215/CJN.09121010. Epub 2011 Apr 14.

    Google Scholar 

  31. Fellström BC, Jardine AG, Schmieder RE, Holdaas H, Bannister K, Beutler J, et al. AURORA Study Group. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis. N Engl J Med. 2009;360(14):1395–407.

    Article  PubMed  Google Scholar 

  32. Strippoli GF, Craig JC. Sunset for statins after AURORA? N Engl J Med. 2009;360(14): 1455–7.

    Article  CAS  PubMed  Google Scholar 

  33. Baigent C, Landray MJ, Reith C, Emberson J, Wheeler DC, Tomson C, et al. SHARP Investigators. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet. 2011;377(9784):2181–92.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Baris Afsar M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Afsar, B. (2014). Review of Current Guidelines: National Cholesterol Education Program and Kidney Disease Outcomes Quality Initiative as They Apply to CKD with Dyslipidemias. In: Covic, A., Kanbay, M., Lerma, E. (eds) Dyslipidemias in Kidney Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0515-7_16

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-0515-7_16

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-0514-0

  • Online ISBN: 978-1-4939-0515-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics