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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.”
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Chang, T. I., Streja, E., Soohoo, M., Kim, T., Rhee, C. M., Kovesdy, C. P., Kashyap, M. L., Vaziri, N. D., Kalantar‐Zadeh, K., & Moradi, H. (2017) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.08730816 · Cited by 67
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Cardiovascular Risk Prediction in Chronic Kidney Disease
Li, X.-J., & Lindholm, B. (2022) · American Journal of Nephrology · doi:10.1159/000528560 · Cited by 65
Lipoprotein(a) and Risk of Myocardial Infarction and Death in Chronic Kidney Disease
Bajaj, A., Damrauer, S. M., Anderson, A. H., Xie, D., Budoff, M. J., Go, A. S., He, J., Lash, J. P., OJO, A. O., Post, W. S., et al. (2017) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.117.309920 · Cited by 69
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“While statins have been shown to decrease cardiovascular complications in patients with CKD, their advantageous impact on eGFR remains ambiguous [142].”
BackgroundImpact of LDL Cholesterol on Microvascular Versus Macrovascular Disease
Emanuelsson, F., Nordestgaard, B. G., Tybjærg‐Hansen, A., & Benn, M. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.07.037 · Cited by 69
“73 m(2) is used as a cut-off for recommended intervention with lipid-lowering therapy (19,30,31).”
MethodEsmeijer, K., Dekkers, O. M., de Fijter, J. W., Dekker, F. W., & Hoogeveen, E. K. (2019) · Scientific Reports · doi:10.1038/s41598-019-53064-x · Cited by 73
Management of dyslipidemia in adult solid organ transplant recipients
Warden, B. A., & Duell, P. B. (2019) · Journal of clinical lipidology · doi:10.1016/j.jacl.2019.01.011 · Cited by 67
Zhang, Z., Wu, P., Zhang, J., Wang, S., & Zhang, G. (2016) · Pharmacological Research · doi:10.1016/j.phrs.2016.01.005 · Cited by 65
The New Dyslipidemia Guidelines: What Is the Debate?
Anderson, T. J., Mancini, G. B. J., Genest, J. J., Grégoire, J. C., Lonn, E., & Hegele, R. A. (2014) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2014.11.007 · Cited by 58
Childhood Obesity and the Metabolic Syndrome
Nehus, E. J., & Mitsnefes, M. M. (2018) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2018.08.004 · Cited by 84
Ndumele, C. E., Rodriguez, F., Dixon, D. L., Khan, S. S., Mukherjee, D., Bajaj, M., Bangalore, S., Bozkurt, B., Breathett, K., Clarke, S. L., et al. (2026) · JACC · doi:10.1016/j.jacc.2026.03.056 · Cited by 90
Li, X., Jiang, D., Jiang, Y.-L., Yu, H., Zhang, M., Jiang, J.-L., He, L., & Yu, H. (2020) · Journal of Clinical Anesthesia · doi:10.1016/j.jclinane.2020.110009 · Cited by 65
Johansen, K. L., Garimella, P. S., Hicks, C. W., Kalra, P. A., Kelly, D., Martens, S., Matsushita, K., Sarafidis, P. A., Sood, M. M., Herzog, C. A., et al. (2021) · Kidney International · doi:10.1016/j.kint.2021.04.029 · Cited by 64
“Tables 2 33,37,38,42,43,56 and 3 highlight key conference recommendations for primary and secondary prevention of stroke in CKD, and the critical research priorities.”
BackgroundMethodTrends in Quality of Care for Patients with CKD in the United States
Tummalapalli, S. L., Powe, N. R., & Keyhani, S. (2019) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.00060119 · Cited by 56
Cognitive disorders in patients with chronic kidney disease: Approaches to prevention and treatment
Pépin, M., Klimkowicz‐Mrowiec, A., Godefroy, O., Delgado, P., Carriazo, S. M., Ferreira, A. C., Golenia, A., Małyszko, J., Grodzicki, T. K., Giannakou, K., et al. (2023) · European Journal of Neurology · doi:10.1111/ene.15928 · Cited by 66
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Hypertriglyceridemia: the importance of identifying patients at risk
Kushner, P. A., & Cobble, M. E. (2016) · Postgraduate Medicine · doi:10.1080/00325481.2016.1243005 · Cited by 47
“required, it should be used cautiously in combination with fibrates due to the increased risk of muscle-related side effects [72].”
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Information and consensus document for the detection and management of chronic kidney disease
Maset, R. G., Bover, J., Segura, J., Diezhandino, M. G., del Hoyo, J. C., Escalada, J., Fácila, L., Gamarra, J., García‐Donaire, J. A., Matarin, L. G., et al. (2022) · Nefrología (English Edition) · doi:10.1016/j.nefroe.2022.07.003 · Cited by 61
Obesity and chronic kidney disease: prevalence, mechanism, and management
Yim, H. E., & Yoo, K. H. (2021) · Korean Journal of Pediatrics · doi:10.3345/cep.2021.00108 · Cited by 58
Kelly, D., & Rothwell, P. M. (2019) · Kidney International · doi:10.1016/j.kint.2019.09.024 · Cited by 45
New perspectives on CKD-induced dyslipidemia
Bermúdez-López, M., Arroyo, D., Betriu, À., Masana, L., Fernández, E., & Valdivielso, J. M. (2017) · Expert Opinion on Therapeutic Targets · doi:10.1080/14728222.2017.1369961 · Cited by 50
“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., An, S., Gao, Y., Xie, E., Zhao, X., Guo, Z., Li, Y., Shen, N., Ren, J., & Zheng, J. (2023) · European journal of medical research · doi:10.1186/s40001-023-00995-x · Cited by 50
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
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 52
“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
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
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
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 49
Cognitive impairment in CKD patients: a guidance document by the CONNECT network
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“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. (2018) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfy151 · Cited by 45
Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines
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Non-immunological complications following kidney transplantation
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Lipid Management in Chronic Kidney Disease: Systematic Review of PCSK9 Targeting
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“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
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 39
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 40
“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
van Oosten, M. J. M., Logtenberg, S. J. J., Hemmelder, M. H., Leegte, M. J. H., Bilo, H. J. G., Jager, K. J., & Stel, V. S. (2021) · Clinical Kidney Journal · doi:10.1093/ckj/sfab120 · Cited by 47
“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
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 105
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
“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
“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 39
“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 40
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
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 42
“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
Metadata
- 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
- FWCI
- 37.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Kidney International (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › 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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