Dyslipidemia in Chronic Kidney Disease: Contemporary Concepts and Future Therapeutic Perspectives

Background: Chronic kidney disease (CKD) is an increasingly prevalent disease state met with great morbidity and mortality primarily resulting from the high incidence of adverse cardiovascular outcomes. Therapeutic strategies in this patient population aim at controlling modifiable cardiovascular risk factors, including dyslipidemia. Summary: In this review article, we first provide the latest pathophysiologic evidence regarding the altered dyslipidemia pattern in CKD, followed by its contemporary management according to the latest guidelines. Moreover, we present the current progress regarding the emerging therapeutic strategies. Key Messages: The presence of renal impairment leads to alterations in cholesterol structure, metabolism, and reverse transport paired with increased oxidative stress. Statins remain the cornerstone of dyslipidemia management in patients with kidney dysfunction who are at risk for cardiovascular events. However, their efficacy is debatable in end-stage renal disease under renal replacement therapy. Therefore, novel treatment approaches aiming at hypertriglyceridemia, proprotein convertase subtilisin/kexin type 9, and lipoprotein(a) are under rigorous investigation while the research of gut microbiome might provide additional mechanistic and therapeutic insight.

Automated summary

Patients with chronic kidney disease (CKD) exhibit alterations in cholesterol structure, metabolism, and transport, along with increased oxidative stress. Statins are still the cornerstone of dyslipidemia management in CKD patients at risk for cardiovascular events, but their efficacy in those with end-stage renal disease on renal replacement therapy is under debate. Novel treatment approaches focusing on hypertriglyceridemia, proprotein convertase subtilisin/kexin type 9, and lipoprotein(a) are being rigorously investigated, while research on the gut microbiome may provide additional insights for mechanistic and therapeutic interventions.