Lecture Code : CKD01-S4
Session Name : Chronic Kidney Disease
Session Topic : Chronic Kidney Disease
Date & Time, Place : June 12 (Fri) / 16:00-17:40 / Room 1 (GBR 101), 1F
Beyond the Guidelines: Tailoring Lipid Management for Optimal Outcomes in CKD
Robert Walker
University of Otago, New Zealand
Dyslipidaemia Associated with Chronic Kidney Disease – tailoring lipid management of optimal outcomes in CKD
Professor Robert Walker. Department of Medicine Dunedin School of Medicine University of Otago Dunedin New Zealand.
Lipid abnormalities associated with CKD are characterised by high triglycerides, low HDL cholesterol, abnormal small oxidised LDL which leads to pro-atherogenic environment and associated higher risk of cardiovascular events. Whilst many patients with CKD do not have the characteristic atherosclerotic features, lipid lowering therapy has been shown to have benefit both in primary prevention as well as secondary prevention.
The landmark SHARP trial, the first major RCT in nephrology, demonstrated a 17% reduction in major atherosclerotic events with the use of simvastatin and ezetimibe, in individuals with CKD grade 3-5. Subsequent meta-analyses have confirmed that statins decrease mortality and cardiovascular events in CKD but have little effect in individuals on dialysis.
Newer agents have been developed for the management of lipid abnormalities including bempedoic acid which inhibits ATP citrate lyase, proprotein convertase substilisin/Kexin type 9 (PCSK9) monoclonal antibodies (Evolocumab and Alirocumab) or siRNA PCSK9 inhibitor (Inclisiran) and CETP inhibitors. There is limited data for their use in CKD but potentially will provide additional lipid-lowering options in CKD.
With the advent of SGLT2 inhibitors and GLP1R agonists which have significant positive metabolic actions, there is increasing evidence that their pleotropic effects lead to reductions in abnormal lipid profiles. Therefore, on-going clinical trials will continue to provide better evidence for the holistic management of individuals with CKD.
Keywords: chronic kidney disease, dyslipidemia, statins, lipid lowering therapy