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Titolo LDL cholesterol in CKD—to treat or not to treat?
Autore Ziad A. Massy1 and Dick de Zeeuw2 - 1Division of Nephrology, Ambroise Pare Hospital, Paris Ile de France Ouest (UVSQ) University, Boulogne Billancourt/Paris, and INSERM U-1088, Amiens, France and 2Department of Clinical Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Referenza Kidney International 2013; doi:10.1038/ki.2013.181

In the majority of patients with chronic kidney disease (CKD) the total and low-density lipoprotein (LDL) cholesterol are usually normal, with the exception of patients with nephrotic-range proteinuria and in peritoneal dialysis patients. Moreover, epidemiological evidence shows that the link between serum total cholesterol or LDL cholesterol and cardiovascular disease (CVD) in CKD is not as straightforward as in the general population. In addition, atherosclerosisrelated events are responsible for onlyB30% of CVD in these patients. Nevertheless, intervention trials, particularly the Study of Heart and Renal Protection, and meta-analyses showed a proportional reduction of cardiovascular risk associated with the absolute reduction in LDL cholesterol in patients with CKD similar to the general population, with apparent attenuation of this relationship in end-stage kidney disease. Therefore, the use of cholesterol-lowering agents appears to be indicated in early CKD stages to prevent atherosclerosis-related risk. However, uncertainty persists as to the optimal management of this risk in end-stage kidney disease patients. In the present review, we discuss these issues and end up with a practical plan aimed to help the nephrologist in managing atherosclerosis-related risk using cholesterol-lowering therapies in CKD patients.

Data 14.01.2014
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