• Vol. 34 No. 1, 31–35
  • 15 January 2005

Hyperlipidaemia in Chronic Kidney Disease

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ABSTRACT

Cardiovascular disease is a major cause of mortality and morbidity in patients with chronic kidney disease (CKD). The prevalence of hyperlipidaemia or dyslipidaemias is much higher compared to the general population. Total or low-density lipoprotein (LDL) cholesterol is highest in patients with chronic renal impairment. The majority of patients with CKD do not develop renal failure; indeed, most of them die of cardiovascular causes before the development of renal failure. The K/DOQI (Kidney Disease Outcomes Quality Initiative) guidelines on dyslipidaemias in CKD suggest that all patients should therefore be evaluated for dyslipidaemias. They should have a complete fasting lipid profile with total, LDL and high-density lipoprotein cholesterol, and triglycerides measured to identify those at risk and those who require treatment. Generally, the treatment approach parallels that suggested by the National Cholesterol Education Program Adult Treatment Panel III guidelines, in which the main focus of treatment is the level of LDL cholesterol. Patients with CKD should be considered a “very high risk” category and aggressive therapeutic intervention initiated to reduce the risk of cardiovascular events.


Patients with chronic kidney disease (CKD) are at an increased risk for cardiovascular disease and have a higher prevalence of hyperlipidaemia (or dyslipidaemias) than the general population.1,2 The risk of cardiovascular disease (CVD) varies depending on the type of lipid abnormalities, the target population, the cause of renal disease and the degree of reduction in glomerular filtration rate (GFR). In patients with pre-existing CVD, the presence of CKD is associated with an increased risk of recurrent cardiovascular events.3 Conversely, most patients with CKD do not develop kidney failure. The majority (58%) of patients die from cardiovascular causes, making CVD the leading cause of death in patients with CKD.4 Indeed, even mild renal insufficiency has been shown to be associated with increased rates of cardiovascular events.5,6 Furthermore, patients on dialysis have 10 to 20 times higher cardiovascular mortality rates than the general population.7 Therefore, it is important to screen all patients with CKD for dyslipidaemias and treat them appropriately as they are considered “a very high-risk” group for CVD.2

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