Cited by 649Lipoproteins and Cardiovascular HealthChronic Kidney Disease and DiabetesDialysis and Renal Disease Management

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KDIGO Clinical Practice Guideline for Lipid Management in CKD: summary of recommendation statements and clinical approach to the patient

Wanner, Christoph, the Kidney Disease: Improving Global Outcomes Lipid Guideline Development Work Group Members, Tonelli, Marcello·2014·Kidney International

DOI 10.1038/ki.2014.31

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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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Background
The Controversies of Coronary Artery Disease in End-Stage Kidney Disease Patients: A Narrative Review
Hirsch, D. S., Lau, B., Kushwaha, V. V., & Yong, K. (2023) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2406181 · Cited by 10
“The 2013 Kidney Disease: Improving Global Outcomes (KDIGO) practice guidelines recommend statins for CVD risk reduction in pre-dialysis CKD patients but propose that statins should not be initiated in ESKD patients receiving chronic dialysis therapy [227].”
Background
Prognostic value of low-density lipoprotein cholesterol in IgA nephropathy and establishment of nomogram model
Tian, Z.-Y., Li, A., Chu, L., Hu, J., Xian, X., & Zhang, H. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1037773 · Cited by 10
Non-High-Density Lipoprotein Cholesterol and Progression of Chronic Kidney Disease: Results from the KNOW-CKD Study
Suh, S.-H.-O., Oh, T. R., Choi, H.-S., Kim, C., Bae, E., Ma, S., Oh, K., Hyun, Y., Sung, S.-A., & Kim, S. (2022) · Nutrients · doi:10.3390/nu14214704 · Cited by 10
“The current guidelines on the management of dyslipidemia in CKD recommends the use of statins, which mainly target low-density lipoprotein cholesterol (LDL-C) levels to prevent cardiovascular (CV) events [4].”
Background
Invasive Management of Coronary Artery Disease in Advanced Renal Disease
Galougahi, K. K., Chadban, S. J., Mehran, R., Bangalore, S., Chertow, G. M., & Ali, Z. A. (2021) · Kidney International Reports · doi:10.1016/j.ekir.2021.02.041 · Cited by 12
“1516 eGFR declines, with no evidence of benefit among patients on dialysis.(35) Proprotein convertase subtilisin/ kexin type 9 inhibition reduces the composite end point of cardiovascular death, MI, stroke, hospitalization for unstable angina, or coronary revascularization in patients with stage G2 CKD (60–90 ml/min p…”
BackgroundInfluential
Cardiovascular risk factors and cardiovascular disease in patients with type 1 diabetes and end-stage renal disease candidates for kidney-pancreas transplantation: Trends from 1999 to 2017
Ruiz, S., Amor, A. J., Pané, A., Andújar, A. M., Montagud‐Marrahí, E., Ventura‐Aguiar, P., Ferrer, J., & Esmatjes, E. (2020) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2020.108135 · Cited by 13
Intensity of statin therapy and renal outcome in chronic kidney disease: Results from the Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease
Jhee, J., Joo, Y. S., Park, J., Yoo, T., Park, S.-K., Jung, J.-Y., Kim, S., Oh, Y., Oh, K., Kang, S.-W., et al. (2020) · Kidney Research and Clinical Practice · doi:10.23876/j.krcp.20.007 · Cited by 10
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Association of Statin Use With Mortality After Dialysis-Requiring Acute Kidney Injury: A Population-Based Cohort Study
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Statin therapy for preventing cardiovascular diseases in patients treated with tacrolimus after kidney transplantation
Han, N., Han, S. H., Song, Y.-K., Kim, M. G., Kim, Y. S., Kim, I., & Oh, J. M. (2017) · Therapeutics and Clinical Risk Management · doi:10.2147/tcrm.s147327 · Cited by 9
“The guideline also provided the “fire-and-forget” strategy that focuses on patients’ original risks of CVD other than lipid status, instead of the “target-to-treat” strategy that titrates the medication dosage to reach a specific target lipid level.(9,10) There are several concerns to consider when interpreting the fi…”
Baseline Characteristics and Prescription Patterns of Standard Drugs in Patients with Angiographically Determined Coronary Artery Disease and Renal Failure (CAD-REF Registry)
Reinecke, H., Breithardt, G., Engelbertz, C., Schmieder, R., Fobker, M., Pinnschmidt, H., Schmitz, B., Bruland, P., Wegscheider, K., Pavenstädt, H., et al. (2016) · PLoS ONE · doi:10.1371/journal.pone.0148057 · Cited by 10
New kidneys, old risks: cardiovascular challenges after transplantation
Craenenbroeck, A. H. V., Chinnappa, S., Dounousi, E. C., Fernández‐Fernández, B., Iatridi, F., Mark, P. B., Piko, N., Stegbauer, J., Torino, C., Vogt, L., et al. (2025) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfaf239 · Cited by 11
“…post-transplant; later use of SGLT2 inhibitors and GLP-1RA; immunosuppressive regimen adjustments to reduce PTDM risk Dyslipidemias KDIGO 2013 [138 ] Statin therapy suggested (2B); no specific LDL-C target defined; PCSK-9 not mentioned; lifestyle changes for hypertriglyceridemia KDOQI 2015…”
Impact of Statins on Mortality and Cardiovascular Outcomes in Dialysis Patients With Atherosclerotic Cardiovascular Disease: A Systematic Review and Meta-Analysis.
Elkoumi, O., Elkoumi, A., Elbairy, M., Irfan, H., Hageen, A., Beddor, A., Khalid, N., Mahmoud, M., Emara, A., Alkhazaleh, U., et al. (2025) · American Journal of Cardiology · doi:10.1016/j.amjcard.2025.07.010 · Cited by 9
Use of Statins for Primary Prevention Among Individuals with CKD in the United States: A Cross-Sectional, Time-Trend Analysis.
Iyalomhe, O., Saparamadu, A. A. D. N. S., & Alexander, G. C. (2024) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2024.11.003 · Cited by 9
Characteristics, management and outcomes in patients with CKD in a healthcare region in Sweden: a population-based, observational study
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Antidyslipidemia Pharmacotherapy in Chronic Kidney Disease: A Systematic Review and Bayesian Network Meta-Analysis
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“Secondly, in contrast to the opinion in the KDIGO Clinical Practice Guideline that HS in CKD was not recommended given its uncertain safety [6], our study indicated that this prescription might be associated with a greater magnitude of risk reduction, with no or few serious adverse events and a negative influence on r…”
Influential
Cardiovascular Disease Assessment Prior to Kidney Transplantation
Ewing, E. C., & Edwards, A. R. (2022) · Methodist DeBakey Cardiovascular Journal · doi:10.14797/mdcvj.1117 · Cited by 7
Serum Low-Density Lipoprotein Cholesterol and Cardiovascular Disease Risk Across Chronic Kidney Disease Stages (Data from 1.9 Million United States Veterans).
Hashemi, L., Hsiung, J.-T., Arif, Y., Soohoo, M., Jackson, N., Gosmanova, E. O., Budoff, M., Kovesdy, C., Kalantar-Zadeh, K., & Streja, E. (2022) · American Journal of Cardiology · doi:10.1016/j.amjcard.2022.01.034 · Cited by 9
Utility of TG/HDL‐c ratio as a predictor of mortality and cardiovascular disease in patients with chronic kidney disease undergoing hemodialysis: A systematic review
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Promoting cardiovascular health post‐transplant through early diagnosis and adequate management of hypertension and dyslipidemia
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Glucose and Lipid Metabolism Abnormalities among Patients with Autosomal Dominant Polycystic Kidney Disease
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Effect of statin on life prognosis in Japanese patients undergoing hemodialysis
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New Goals and Strategies of Chinese Medicine in Prevention and Treatment of Chronic Kidney Disease
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Lipid lowering in renal disease
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Statin therapy lowers the risk of new-onset atrial fibrillation in patients with end-stage renal disease
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Associations Between Global Population Health Indicators and Dialysis Variables in the Monitoring Dialysis Outcomes (MONDO) Consortium
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“…Diabetes Dialyse) study, AURORA (A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis) study, and sub-group analysis of SHARP [101–103], current guidelines recommend against initiation of statins in persons on hemodialysis (Table 3), the dialysis paradox [3, 98–100].”
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Association between dyslipidemia and the risk of incident chronic kidney disease affected by genetic susceptibility: Polygenic risk score analysis
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Are there lost opportunities in chronic kidney disease? A region-wide cohort study
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Targeting Pharmacotherapies for Inflammatory and Cardiorenal Endpoints in Kidney Disease
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Clinical conundrums involving statin drug-drug interactions
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Lipid management to mitigate poorer postkidney transplant outcomes
Skulratanasak, P., & Larpparisuth, N. (2022) · Current Opinion in Nephrology & Hypertension · doi:10.1097/mnh.0000000000000841 · Cited by 10
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Method
Arterial Stiffness as a Cardiovascular Risk Factor After Successful Kidney Transplantation in Diabetic and Nondiabetic Patients
Heleniak, Z., Illersperger, S., Małgorzewicz, S., Dębska-Ślizień, A. M., Budde, K., & Halleck, F. (2022) · Transplantation Proceedings · doi:10.1016/j.transproceed.2022.07.007 · Cited by 9
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CKD: The burden of disease invisible to research funders
AIRG-E, EKPF, ALCER, FRIAT, REDINREN, RICORS2040, SENEFRO, SET, & ONT (2022) · Nefrología (English Edition) · doi:10.1016/j.nefroe.2021.09.005 · Cited by 22
HbA1c and beyond
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Working Toward an Improved Understanding of Chronic Cardiorenal Syndrome Type 4.
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The association of high sCD163/sTWEAK ratio with cardiovascular disease in hemodialysis patients
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Recent developments in kidney transplantation in children
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Optimizing care for chronic kidney disease: Considerations from A to Z
Chen, F.-Y., Chang, W., Kao, Z.-K., Tan, A. C., Li, S., Yang, C.-Y., Lin, H., & Lin, C.-C. (2025) · Journal of the Chinese Medical Association · doi:10.1097/jcma.0000000000001280 · Cited by 4
The role of maintaining lower LDL-C level during statin treatment for advanced CKD patients.
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Counteracting TGM2 by a Fibroin peptide ameliorated Adriamycin-induced nephropathy via regulation of lipid metabolism through PANX1-PPAR α/PANK1 pathway.
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“Based on this evidence, The Kidney Disease: Improving Global Outcomes (KDIGO) 2013 guideline suggests neither initiating nor discontinuing statins in patients at or after dialysis initiation for the primary prevention of CV disease, and this guideline did not offer specific recommendations on secondary prevention of C…”
Background
Elevated postprandial triglyceride-rich lipoproteins in patients with diabetes and stable coronary artery disease correlated with early renal damage and systemic inflammation
Guo, X., Zhai, Y., Song, C., Mi, Z., Peng, J., Guo, J., Teng, X., & Zhang, D. (2023) · Lipids in Health and Disease · doi:10.1186/s12944-023-01820-4 · Cited by 7
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Background
Use of lipid‐lowering therapies in patients with chronic kidney disease and atherosclerotic cardiovascular disease: 2‐year results from Getting to an imprOved Understanding of Low‐Density lipoprotein cholesterol and dyslipidemia management (GOULD)
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“Both the 2013 KDIGO and 2018 ACC/AHA cholesterol guidelines recommend at least statin therapy for non‐dialysis dependent CKD patients with ASCVD given that CKD is a major risk factor for progression of ASCVD, particularly with worsening CKD.”
BackgroundInfluential
Hydrophilic Versus Lipophilic Statin Treatments in Patients With Renal Impairment After Acute Myocardial Infarction
Kang, M. H., Kim, W., Kim, J. S., Jeong, K., Jeong, M., Hwang, J.-Y., Hur, S., & Hwang, H. (2022) · Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease · doi:10.1161/jaha.121.024649 · Cited by 7
Association of diuretic use with increased risk for long-term post-transplantation diabetes mellitus in kidney transplant recipients
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“022 Dialysis duration, months 32 (13-62) 24 (6-48) 0.”
A Prognostic Merit of Statins in Patients with Chronic Hemodialysis after Percutaneous Coronary Intervention—A 10-Year Follow-Up Study
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“Accordingly, despite no recommendation concerning the initiation of statins, guidelines paradoxically encourage the continuation of statins in patients who were already receiving them before the introduction of dialysis [12,16,17,25].”
Background
Statins, obesity, and the microbiome: A potential mechanism for the pleiotropic effects of statin therapy.
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A Primer on Quality Assurance and Performance Improvement for Interprofessional Chronic Kidney Disease Care: A Path to Joint Commission Certification
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Outcomes of radiocephalic fistula created by nephrologists
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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
ORCID: Wanner, Christoph
Tonelli, Marcello
Venue: Kidney International
Publisher: Elsevier BV
Published: 2014-06
Volume: 85
Issue: 6
Pages: 1303-1309
ISSN: 0085-2538 (ISSN-L)
DOI: 10.1038/ki.2014.31
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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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KDIGO Clinical Practice Guideline for Lipid Management in CKD: summary of recommendation statements and clinical approach to the patient

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