Management of Dyslipidemia in Long-Term Dialysis Patients

Introduction

Dyslipidemia is commonly observed in adults treated with hemodialysis (HD) and peritoneal dialysis (PD). The most prevalent pattern is increased plasma triglyceride concentrations (linked to an accumulation of triglyceride-enriched apolipoprotein-B particles) and decreased plasma concentrations of high-density lipoprotein (HDL). In addition, PD patients usually have increased low-density lipoprotein (LDL) concentrations. Atherogenic changes in the composition of lipoproteins have also been documented in HD and PD patients. Dialysis patients experience grossly elevated risks of cardiovascular events and mortality. Accordingly, evidence of the benefits and harms of lipid management on cardiovascular risk in the setting of dialysis is of central importance to clinical practice.

In contrast to the general population and adults with cardiovascular disease, lipid abnormalities inversely correlate with cardiovascular disease and all-cause mortality in observational studies among HD and PD patients. Notably, higher levels of serum total and LDL cholesterol are associated with lower risks of total and cardiovascular death, which may in part be explained by effect modification from systemic inflammation and/or malnutrition, which are independently associated with poor outcomes.

Uncertainty about the effects of lipid-lowering treatment in end-stage kidney disease (ESKD) patients has occurred due to differing conclusions among large, randomized trials of statin therapy with or without ezetimibe. Numerous randomized controlled trials evaluating lipid management in the dialysis setting are available. This chapter examines existing data for treatment effects of lipid management among ESKD.