KDIGO Clinical Practice Guideline for Lipid Management in CKD: summary of recommendation statements and clinical approach to the patient
Abstract
The Kidney Disease: Improving Global Outcomes (KDIGO) organization developed clinical practice guidelines on lipid management for all adults and children with chronic kidney disease (CKD). Thirteen recommendations were obtained from the available evidence outlining a three-step management including assessment in all, treatment in many, and follow-up measurements in few. A key element is the recommendation of statin or statin/ezetimibe treatment in adults aged ⩾50 years with estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m(2) but not treated with chronic dialysis or kidney transplantation. In dialysis patients, the magnitude of any relative reduction in risk appears to be substantially smaller than in earlier stages of CKD and initiation of statin treatment is not recommended for most prevalent hemodialysis patients. In the past, clinical practice guidelines suggested the use of targets for LDL cholesterol, which require repeated measurements. Treatment escalation with higher doses of statin would be a consequence when LDL cholesterol targets are not met. The KDIGO Work Group did not recommend this strategy because higher doses of statins have not been proven to be safe in the setting of CKD. Since LDL cholesterol levels do not necessarily suggest the need to increase statin doses, follow-up measurement of lipid levels is not recommended.
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Statin therapy is a cornerstone of therapy for the primary and secondary prevention of ASCVD among people with diabetes and CKD.
“Statin therapy is a cornerstone of therapy for the primary and secondary prevention of ASCVD among people with diabetes and CKD.”
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“Finally, although hypertriglyceridemia is frequently present in CKD patients, fibric acid derivatives are only used in cases of markedly elevated fasting TG (>1000 mg/dL) and should not be combined with statins because of potential toxicity [79].”
BackgroundInfluentialYe, Z.-X., An, S., Gao, Y.-X., Xie, E.-M., Zhao, X., Guo, Z.-Y., Li, Y.-K., Shen, N., Ren, J.-Y., & Zheng, J.-G. (2023) · European Journal of Medical Research · doi:10.1186/s40001-023-00995-x · Cited by 44
Verbeke, F., Siwy, J., van Biesen, W., Mischak, H., Pletinck, A., Schepers, E., Neirynck, N., Magalhães, P., Pejchinovski, M., Pontillo, C., et al. (2019) · Nephrology, Dialysis and Transplantation · doi:10.1093/ndt/gfz242 · Cited by 44
Kim, H., Kim, K. H., Ahn, S. V., Kang, S., Yoo, T., Ahn, H. S., Hann, H. J., Lee, S., Ryu, J., Yu, M., et al. (2015) · International Journal of Cardiology · doi:10.1016/j.ijcard.2015.06.120 · Cited by 46 · see citing works
Risk Factors and Cardiovascular Disease in the Elderly
Díez‐Villanueva, P., Jiménez-Méndez, C., Bonanad, C., García‐Blas, S., Pérez-Rivera, J.-Á., Miguel, G. A., García‐Pardo, H., Formiga, F., Camafort, M., Martínez‐Sellés, M., et al. (2022) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2306188 · Cited by 51 · see citing works
“Statins must be included for lipid control, but high-dose regimes should be avoided [70].”
BackgroundHirano, T., Satoh, N., Kodera, R., Hirashima, T., Suzuki, N., Aoki, E., Oshima, T., Hosoya, M., Fujita, M., Hayashi, T., et al. (2021) · Journal of Diabetes Investigation · doi:10.1111/jdi.13697 · Cited by 42 · see citing works
The effect of chronic kidney disease on lipid metabolism
Di̇nçer, N., Dağel, T., Afşar, B., Covic, A. C., Ortíz, A., & Kanbay, M. (2018) · International Urology and Nephrology · doi:10.1007/s11255-018-2047-y · Cited by 42 · see citing works
Streja, E., Gosmanova, E. O., Molnar, M. Z., Soohoo, M., Moradi, H., Potukuchi, P. K., Kalantar‐Zadeh, K., & Kovesdy, C. P. (2018) · JAMA Network Open · doi:10.1001/jamanetworkopen.2018.2311 · Cited by 41 · see citing works
Managing Diabetes and Cardiovascular Risk in Chronic Kidney Disease Patients
Lovre, D., Shah, S., Sihota, A., & Fonseca, V. A. (2017) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2017.10.006 · Cited by 48 · see citing works
Cognitive impairment in CKD patients: a guidance document by the CONNECT network
Bolignano, D., Simeoni, M., Hafez, G., Pépin, M., Gallo, A., Altieri, M., Liabeuf, S., Giannakou, K., De, A., Capasso, G., et al. (2024) · Clinical Kidney Journal · doi:10.1093/ckj/sfae294 · Cited by 36 · see citing works
“Statin/ezetimibe treatment is thus currently recommended in adults ≥ 50 years old with an eGFR 60 ml/min/1.73 m 2 on conservative therapy, but also in dialysis patients if initiated before renal replacement therapy start and in kidney transplant recipients if tolerated [112 ].”
InfluentialMetabolic risk profile in kidney transplant candidates and recipients
Piotti, G., Gandolfini, I., Palmisano, A., & Maggiore, U. (2019) · Nephrology, Dialysis and Transplantation · doi:10.1093/ndt/gfy151 · Cited by 41 · see citing works
Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines
Drapkina, O. M., Васильевна, К. А., Калинина, А. М., Avdeev, S. N., Викторович, А. М., Алексеева, Л. И., Almazova, I. I., Andreenko, Е. Y., Antipushina, D. N., Balanova, Y. А., et al. (2024) · CARDIOVASCULAR THERAPY AND PREVENTION · doi:10.15829/1728-8800-2024-3996 · Cited by 49 · see citing works
Non-immunological complications following kidney transplantation
Cohen‐Bucay, A., Gordon, C. E., & Francis, J. M. (2019) · F1000Research · doi:10.12688/f1000research.16627.1 · Cited by 41 · see citing works
Lipid Management in Chronic Kidney Disease: Systematic Review of PCSK9 Targeting
Zheng-Lin, B., & Ortíz, A. (2018) · Drugs · doi:10.1007/s40265-017-0858-2 · Cited by 39 · see citing works
“The most recent Clinical Practice Guideline elaborated by KDIGO was published in 2013, and offered evidence-based recommendations on lipid management in patients with CKD, including those on prevalent hemodialysis and kidney transplant recipients (Table 3) [6].”
BackgroundInfluentialAlbuminuria is Not an Appropriate Therapeutic Target in Patients with CKD
Fried, L. F., & Lewis, J. B. (2015) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.10681014 · Cited by 42 · see citing works
Trial of Pegcetacoplan in C3 Glomerulopathy and Immune-Complex MPGN.
Fakhouri, F., Bomback, A., Ariceta, G., Delmas, Y., Dixon, B. P., Gale, D. P., Greenbaum, L. A., Han, S. H., Isbel, N., Quintrec, M. L., et al. (2025) · New England Journal of Medicine · doi:10.1056/nejmoa2501510 · Cited by 38
Kanbay, M., Güldan, M., Özbek, L., Çöpür, S., Covic, A. S., & Covic, A. C. (2024) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2024.07.014 · Cited by 37 · see citing works
Management of traditional risk factors for the development and progression of chronic kidney disease
Lo, R. H., Narasaki, Y., Lei, S., & Rhee, C. M. (2023) · Clinical Kidney Journal · doi:10.1093/ckj/sfad101 · Cited by 39 · see citing works
“For adults aged 18–49 with CKD, the guidelines recommend statin therapy if there is also one of the following comorbidities: known coronary disease, diabetes mellitus, previous ischaemic stroke, or 10-year risk of coronary death or non-fatal myocardial infarction > 10% [54].”
BackgroundCKD: The burden of disease invisible to research funders
AIRG-E, EKPF, ALCER, FRIAT, REDINREN, RICORS2040, SENEFRO, SET, & ONT (2021) · Nefrología · doi:10.1016/j.nefro.2021.09.004 · Cited by 51 · see citing works
van Oosten, M. V., Logtenberg, S., Hemmelder, M., Leegte, M. J. H., Bilo, H., Jager, K., & Stel, V. (2021) · Clinical Kidney Journal · doi:10.1093/ckj/sfab120 · Cited by 37
“Guidelines suggest that statins should not be routinely ‘initiated’, though they should be continued when patients already use statins when initiating dialysis treatment [44].”
BackgroundLin, J. J., Reilly, M. P., Terembula, K., & Wilson, F. P. (2014) · PLoS ONE · doi:10.1371/journal.pone.0114397 · Cited by 36 · see citing works
Post-Transplant Cardiovascular Disease
Birdwell, K. A., & Park, M. (2021) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.00520121 · Cited by 100 · see citing works
Chuang, A., Nguyen, M. T., Kung, W., Lehman, S. J., & Chew, D. P. (2020) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm.2020.02.17 · Cited by 40 · see citing works
“ing Global Outcomes) guideline recommendations support the use of statin therapy in stage 3-4 CKD (Wanner and Tonelli, 2014), but not in a dialysed patient given the negative result from the 4D (Wanner et al.”
BackgroundLin, M.-H., Chiu, S.-Y., Chang, P.-H., Lai, Y.-L., Chen, P.-C., & Ho, W. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17051494 · Cited by 36 · see citing works
“For patients with dialysis, guidelines of the 2013 kidney disease: improving global outcomes (KDIGO) and the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) advise that statins treatment should not be administered routinely [11,12], Thus, the probability of being exposed to statins is hig…”
BackgroundStabouli, S., Polderman, N., Nelms, C. L., Paglialonga, F., Oosterveld, M. J. S., Greenbaum, L. A., Warady, B. A., Anderson, C. E., Haffner, D., Desloovere, A., et al. (2021) · Pediatric Nephrology · doi:10.1007/s00467-021-05148-y · Cited by 37 · see citing works
“The 2013 KDIGO clinical practice guideline for lipid management in CKD did not suggest the initiation of statins or a statin/ ezetimibe combination in CKD patients under 18 years due to the lack of long-term safety data and the low level of evidence for benefit [115].”
MethodBenefit of Ezetimibe Added to Simvastatin in Reduced Kidney Function
Stanifer, J. W., Charytan, D. M., White, J. A., Lokhnygina, Y. V., Cannon, C. P., Roe, M. T., & Blazing, M. A. (2017) · Journal of the American Society of Nephrology · doi:10.1681/asn.2016090957 · Cited by 39 · see citing works
Concordance With Screening and Treatment Guidelines for Chronic Kidney Disease in Type 2 Diabetes
Edmonston, D., Lydon, E., Mulder, H., Chiswell, K., Lampron, Z. M., Marsolo, K., Goss, A., Ayoub, I., Shah, R. C., Chang, A. R., et al. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.18808 · Cited by 34 · see citing works
Statins and All‐Cause Mortality in Patients Undergoing Hemodialysis
Jung, J., Bae, G. H., Kang, M., Kim, S. W., & Lee, D. H. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.119.014840 · Cited by 40 · see citing works
“CKD is an important risk-enhancing factor for atherosclerotic cardiovascular diseases and is a reasonable indication for statin therapy.(2,3) However, an important concern is that the beneficial effects of statin therapy may not be maintained in patients with advanced CKD.”
Background
- Authors
- Wanner, C., the Kidney Disease: Improving Global Outcomes Lipid Guideline Development Work Group Members, & Tonelli, M.
- Affiliations
- University of Würzburg (DE)
- University of Alberta (CA)
- Corresponding author
- Wanner, Christoph
- Venue
- Kidney International
- Publisher
- Elsevier BV
- Published
- 2014-06
- Volume
- 85
- Issue
- 6
- Pages
- 1303-1309
- ISSN
- 0085-2538 (ISSN-L)
- OpenAlex
- W1978239396
- Cited by
- 649
- References
- 0
- Citations by year
- 2026: 41 · 2025: 65 · 2024: 65 · 2023: 77 · 2022: 68 · 2021: 61 · 2020: 58 · 2019: 57 · 2018: 41 · 2017: 35 · 2016: 33 · 2015: 31 · 2014: 15 · 2012: 1
- FWCI
- 37.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Kidney International (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Keywords
- lipid control, chronic kidney disease, statins, ezetimibe, LDL cholesterol targets, statin dose escalation, hemodialysis, estimated glomerular filtration rate, cardiovascular risk reduction
- MeSH terms
- Adolescent, Adult, Age Factors, Hypolipidemic Agents, Child, Renal Dialysis, Humans, Lipids, Middle Aged, Nephrology, Risk Factors, Biomarkers, Treatment Outcome, Evidence-Based Medicine, Dyslipidemias, Renal Insufficiency, Chronic, Young Adult
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