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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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Braund, R. (2020) · Advanced Clinical Pharmacy - Research, Development and Practical Applications · doi:10.1007/978-3-030-37655-0 · Cited by 3
“The fractional excretion of sodium in the urine is increased by the remaining func- Adapted from the KDIGO Clinical Practice Guideline for Lipid Management in CKD 2013 (Wanner and Tonelli 2014) Dose based on 14D, 2ALERT, 3AURORA, 4SHARP.”
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InfluentialBahl, A., Prasad, N., Sinha, D. P., Ganguly, K., Roy, S., Roy, D., Rakshit, S., Kumar, D. L., Das, S., Bhasin, D., et al. (2025) · Indian Heart Journal · doi:10.1016/j.ihj.2025.03.012 · Cited by 2
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Zaheer, A., Saeed, H., Arshad, M. K., Iftikhar, U., Abid, A., Khan, M. H., Khan, A., & Akbar, A. (2024) · Cardiology in Review · doi:10.1097/crd.0000000000000816 · Cited by 2
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“14 The Research Ethics Committee approved the study at the National Taiwan University Hospital and waived the need for participant consent.”
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Chang, H.-H., Liu, W.-C., & Tsai, T. (2023) · International Urology and Nephrology · doi:10.1007/s11255-023-03681-3 · Cited by 2
“To reduce cardiac death in patients with CKD, the Kidney Disease Improving Global Outcomes guideline recommends that all patients aged ≥ 50 years with any CKD stages and even young patients with CKD possessing risk factors of cardiovascular disease (CVD) should receive statin therapy [30].”
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Arif, H., & Yadav, A. (2021) · Current Opinion in Nephrology & Hypertension · doi:10.1097/mnh.0000000000000709 · Cited by 2
“In the wake of the 4D [56], AROURA [57] and the SHARP trials [58], the recommendations by KDIGO are to treat hyperlipidaemia in patients with CKD, not on dialysis aged at least 50 years with either statins or statin and ezetimibe [59].”
MethodRisk Factors and Management of Kidney Diseases in Saudi Women with Diabetes
Siddiqui, K., & Joy, S. S. (2020) · Current Women s Health Reviews · doi:10.2174/1573404816666200206110002 · Cited by 2
Pablo Amair, M., & Arocha-Rodulfo, I. (2020) · Revista Colombiana de Nefrología · doi:10.22265/acnef.7.1.356 · Cited by 2
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Lee, K., Chan, G., & Tang, S. (2020) · Nephrology, Dialysis and Transplantation · doi:10.1093/ndt/gfaa051 · Cited by 2
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“The 2013 Lipid Guidelines discuss dietary changes to reduce serum triglycerides,with thecaveat that it is aweakrecommendation,made on the basis of very low-quality evidence (9).”
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“Severe renal impairment alters the pharmacokinetics of statins by reducing renal elimination and requires dose reduction to limit deleterious effects including myositis and rhabdomyolysis [12,13].”
Arrieta, F., Iglesias, P., Pedro‐Botet, J., Becerra, A., Ortega, E., Obaya, J. C., Nubiola, A., Maldonado, G. F., Campos, M. D. M., Petrecca, R., et al. (2018) · Clínica e Investigación en Arteriosclerosis (English Edition) · doi:10.1016/j.artere.2018.05.002 · Cited by 10
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“Por otro lado, pacientes que ya eran usuarios de estatinas pueden continuarla cuando entran a diálisis (Wanner & Tonelli, 2014).”
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Rinat, C., Nir, A., & Frishberg, Y. (2016) · doi:10.1016/j.ppedcard.2015.11.002 · Cited by 2
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Chapter 56 – Management of Dyslipidemia in Long-Term Dialysis Patients
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“10,11 Currently, there is paucity of data regarding the clinical profile and its association to clinical outcomes among patients who are on chronic hemodialysis and are hospitalized for ACS.”
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Arabi, Z., Tawhari, M. H., Arabi, T., Alaklabi, A., Fallatah, W., Sabbah, B., AlGhamdi, A. A. A., Alnasrullah, A., & Shafqat, A. (2025) · Annals of Medicine and Surgery · doi:10.1097/ms9.0000000000003903 · Cited by 1
“However, the effect of KTx cannot be ethically assessed without the use of statins since the use of statins in this high-risk group is considered standard of care [ 13 ] .”
InfluentialTang, L., Xu, D., Xu, L., Zhao, Y., Zhu, Y.-D., Lv, J., Yang, L., & Zheng, X. (2025) · Frontiers in Medicine · doi:10.3389/fmed.2025.1639130 · Cited by 2
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Lipid and immunophenotypic profiles in hemodialysis patients with citrate vs. acetate dialysates
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Prescribing patterns in older people with advanced chronic kidney disease towards the end of life
Letts, M., Chesnaye, N. C., Pippias, M., Caskey, F. J., Jager, K. J., Dekker, F. W., van Diepen, M., Evans, M., Torino, C., Vilasi, A. D., et al. (2024) · Clinical Kidney Journal · doi:10.1093/ckj/sfae301 · Cited by 2
Self-citationProprotein convertase subtilisin/kexin type 9 (PCSK9) and clinical outcomes in dialysis patients
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“26,27 28 However, some statins need dosage adjustments based on creatinine clearance.”
BackgroundStroke and kidney transplantation
Abreo, A. P., Kataria, D., Amrutkar, C. V., Singh, A., Samaniego, M., & Singh, N. K. (2023) · Current Opinion in Organ Transplantation · doi:10.1097/mot.0000000000001078 · Cited by 1
“However, follow-up is recommended in a select group of patients (Table 2) [54].”
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“Current lipid treatment recommendations from KDIGO for PD patients suggest that statin treatments are not effective at reducing CV risk and while triglyceride targeting medications like fibrates can reduce risk the increase in plasma creatinine contraindicates them for use in this population 17 .”
Diabetische Nierenerkrankung (Update 2023)
Sourij, H., Edlinger, R., Prischl, F. C., Kaser, S., Horn, S., Antlanger, M., Paulweber, B., Aberer, F., Brix, J. M., Cejka, D., et al. (2023) · Wiener klinische Wochenschrift · doi:10.1007/s00508-022-02147-3 · Cited by 1
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“Applying recommendations of the 2013 KDIGO guidelines [10], the following patients should be considered for receiving statins: (a) patients > 50 years with CKD (grades 3–5, without dialysis), regardless of LDL-C levels; (b) patients < 50 years with CKD (grades 3–5, without dialysis), with cardiovascular disease histor…”
BackgroundMethodKidney Function and Lipid Levels in Older Adults: The Atherosclerosis Risk in Communities Study
Srivastava, S., Coresh, J., Rebholz, C., Grams, M., Matsushita, K., Martin, S., & Shin, J.-I. (2022) · Kidney Medicine · doi:10.1016/j.xkme.2022.100494 · Cited by 1
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Nelms, C., Shroff, R., Boyer, O., & Topaloğlu, R. (2022) · Advances in Chronic Kidney Disease · doi:10.1053/j.ackd.2022.04.004 · Cited by 1
Screening for Cardiovascular Disease in CKD: COMMENTARY.
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“We agree with the general concept of risk assessment in patients with CKD, and support the KDIGO lipid guidelines which state that the vast majority of patients with CKD and above the age of 50 years are at high risk for CAD and should take statins.(3) We also agree with tight BP control, healthy diet, and improved gl…”
ResultArrieta, F., Pedro‐Botet, J., Iglesias, P., Obaya, J. C., Montánez, L., Maldonado, G. F., Becerra, A., Navarro, J., Perez, J. C., Petrecca, R., et al. (2022) · Clínica e Investigación en Arteriosclerosis (English Edition) · doi:10.1016/j.artere.2022.01.005 · Cited by 1
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Lee, S. M., Son, Y. K., Kim, S. E., Kim, Y. H., Park, Y., & An, W. S. (2021) · Kidney Research and Clinical Practice · doi:10.23876/j.krcp.20.247 · Cited by 1
Advanced kidney disease: What the nonnephrology NP needs to know.
Puzantian, H., & Mead, D. R. (2020) · The Nurse Practitioner · doi:10.1097/01.npr.0000722304.42807.02 · Cited by 1
“In cardiovascular disease prevention, low to moderate doses of statins can be used in patients with CKD starting at 50 years of age.(13,27) Statin initiation is not recommended for patients on kidney replacement therapies as there is no clear evidence of cardiovascular or survival benefi t.”
BackgroundEffect of atorvastatin on inflammatory markers in hemodialysis patients
Hussein, H., Mady, G., Shawky, S., Omran, N. A., & Teama, N. (2020) · The Egyptian Journal of Internal Medicine · doi:10.1186/s43162-020-00007-y · Cited by 1
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Links lipoproteins to chronic kidney disease and atherosclerosis
Lu, H. S., Kukida, M., & Daugherty, A. (2019) · Current Opinion in Lipidology · doi:10.1097/mol.0000000000000625 · Cited by 1
Kroonen, M., Stevens, J., de Zeeuw, D., & Heerspink, H. (2019) · Diabetes, obesity and metabolism · doi:10.1111/dom.13849 · Cited by 1
“Lipid-lowering therapy is part of the guideline recommended treatment for cardiovascular protection in patients with diabetes and chronic kidney disease.(1) The effects of statins on kidney function remain unclear.”
BackgroundGremese, E., Lorenzis, E. D., & Ferraccioli, G. (2018) · Journal of Rheumatology · doi:10.3899/jrheum.180732 · Cited by 1
Statins at Dialysis Transition-Supportive but Not Sufficient.
Edmonston, D., Wolf, M., & Pencina, M. (2018) · JAMA Network Open · doi:10.1001/jamanetworkopen.2018.2411 · Cited by 1
Dyslipidemias in CKD and ESKD: Outcomes and Management
Carruthers, D., & Rohatgi, A. (2017) · Springer eBooks · doi:10.1007/978-3-319-56042-7_35 · Cited by 1
Bah, A., Bah, M. L., Péquignot, R., & Kimso, O. (2015) · doi:10.4172/2161-0959.1000217 · Cited by 1
“Acute renal failure has been classified as recommended by KDIGO [5].”
BackgroundDoes pharmacotherapy improve cardiovascular outcomes in hemodialysis patients?
Mittal, M., Aggarwal, K. B., Littrell, R. L., Agrawal, H., & Alpert, M. (2015) · Hemodialysis International · doi:10.1111/hdi.12352 · Cited by 1
Primary Care of the Solid Organ Transplant Recipient
Wong, C. J. (2020) · Springer eBooks · doi:10.1007/978-3-030-50629-2 · Cited by 19
“Still, despite the weak supporting evidence, it is the recommendation of the KDIGO work group that all post-kidney transplant patients be treated with statin therapy [69].”
Heart Failure in a Patient with End-Stage Kidney Disease on Renal Replacement Therapy
Ahmadmehrabi, S., Rincon-Choles, H., & Tang, W. H. W. (2019) · Springer eBooks · doi:10.1007/978-3-030-21033-5_8
Management of Overt Diabetic Kidney Disease and Uremia
Schernthaner, G., & Prischl, F. C. (2016) · Springer eBooks · doi:10.1007/978-3-319-08873-0_5 · Cited by 1
Progression of Chronic Kidney Disease and Nephroprotective Therapy
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Wytyczne PTL/KLRwP/PTK dotyczące postępowania w zaburzeniach lipidowych dla lekarzy rodzinnych 2016
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Documento de información y consenso para la detección y manejo de la enfermedad renal crónica
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Kim, B., Kim, H.-J., Kim, J., Choi, N., & Shin, J.-H. (2026) · Annals medicus · doi:10.1080/07853890.2026.2745096
Baharani, J., & Ramachandran, S. (2026) · Lipidology · doi:10.3390/lipidology3030025
“Treatment decisions in G3b–G5 should therefore be individualised, weighing ASCVD burden, life expectancy and patient goals through shared decision-making [4,24].”
Kordonova, O. O., Gubarev, K., Voskanyan, S., Svetlakova, D. S., Khayrullin, I. R., Abalyan, A. K., Petizheva, I. A., Shchekaturov, S., Vyunkova, Y. N., Kurakina, Z. I., et al. (2026) · Transplantologiya. The Russian Journal of Transplantation · doi:10.23873/2074-0506-2026-18-3-374-394
Yang, G., Zhang, D. Y., Fischman, C. J., Cuchel, M., Suszták, K., & Rader, D. J. (2026) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2026.06.015
Pourkia, R., Saravi, M., Asgharpour, M., Ziaie, N., Akbari, R., Shirafkan, H., & Nabipour, M. (2026) · Caspian Journal of Internal Medicine · doi:10.22088/cjim.17.3.582
“Predialysis patients were defined as GFR less than 30 Ml/Min/1.73m2 (15).”
Forrest, A. S., Majety, P., Mayer, S., & Ganda, O. P. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.71180
Beyond LDL-C: Modern Lipid Management for ASCVD Prevention in Primary Care
Carlson, A. M., Zayyad, Z. A., Driesenga, S., Boxley, P., Mishra, A., Uraizee, O., Ephrem, R., Zhang, R., Natsheh, Z., & Shroff, A. R. (2026) · Cardiology and Therapy · doi:10.1007/s40119-026-00473-5
“Given this data, in dialysis-dependent adults, recommendations are to continue but not initiate statin therapy [75].”
InfluentialFujinami, H., Ando, T., Shibahara, N., Fujita, Y., & Shin, T. (2026) · Journal of Nippon Medical School = Nippon Ika Daigaku zasshi · doi:10.1272/jnms.jnms.2026_93-407
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“For CVD treatment optimization, statin therapy was provided to all individuals [47, 48], one BP medication was provided to all untreated hypertensive patients, and one BP medication was added to those with hypertension who are currently uncontrolled (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg) on treatment.”
Asgari, E., Corr, M., Ferro, C., Fossati, N., Graham-Brown, M., Howse, M., Jeetley, P., Jones, G., Kelly, D., Kojro, A., et al. (2026) · Transplantation reviews · doi:10.1016/j.trre.2026.101048
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“[17] • Dose-Dependency: Higher dosing regimens (e.g., 80 mg/day) and the use of high-potency statins are associated with a stronger signal for both muscle and renal toxicity.”
Lin, Y.-C., Lai, T.-S., Chou, Y.-H., Lin, S.-L., Huang, J.-W., & Tu, Y.-K. (2026) · Renal Failure · doi:10.1080/0886022x.2026.2694246
Lipid-lowering for people with chronic kidney disease: a narrative review
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Kardiovaskuläre Erkrankungen bei chronischer Nierenerkrankung
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“These pathophysiological mechanisms accelerate atherosclerosis and substantially increase the incidence of major adverse cardiovascular events (MACE), particularly in patients with CKD stages 4 and 5 (3).”
InfluentialChen, J., Gao, X., Meng, X., Lou, X., & Chen, J. (2026) · Lipids in Health and Disease · doi:10.1186/s12944-026-02996-1
“Given that Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend statins for most recipients [47], the lack of adjustment for lipid-lowering therapy represents an important limitation.”
Mohammed, A. S., Takagi, M., Yasmeen, U., Desai, R., Ramaiyah, S., Vasudeva, R., Parmar, G. M., & Gupta, K. (2026) · Cardiology in Review · doi:10.1097/crd.0000000000001306
Chronic Kidney Disease and Its Role in Cardiovascular Disease.
Swamynathan, R., Dolan, L., Frishman, W., & Aronow, W. (2026) · Cardiology in Review · doi:10.1097/crd.0000000000001309
Johnsi Priya, J., Nusrath, A., P., R., S., S. B., & S, I. (2026) · Cureus · doi:10.7759/cureus.108090
Temporal Trends in the Complexity of Nephrology Inpatients: A Population-Based Cohort Study.
Ghimire, A., Wiebe, N., Hemmelgarn, B. R., Manns, B., & Tonelli, M. (2026) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2026.03.042
Self-citationJiang, W., Zhang, F., Zhang, X., Zhong, Y., & Chen, Y. (2026) · Renal Failure · doi:10.1080/0886022x.2026.2646035
Malmquist, J., Davidge, J., Bjurström, K., Halling, A., & Agvall, B. (2026) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2026.2636586
“…data from the UK Biobank, have shown that combining eGFR with albuminuria improves cardiovascular risk prediction compared to traditional models [24]. these findings support the integration of renal function and albuminuria into routine cardiovascular risk assessments in primary care [5,9,24].”
InfluentialPracoń, R., Anthopolos, R., Lu, Y., Demkow, M., Mazurek, T., Drożdż, J., Pruszczyk, P., Roik, M., Kryczka, K., Henzel, J., et al. (2026) · Postepy w kardiologii interwencyjnej = Advances in interventional cardiology · doi:10.5114/aic.2026.160027
“…clinical trials of statin therapy in patients on dialysis (AURORA and 4D), KDIGO clinical practice guidelines advised against initiating statin therapy in this population of patients but recommended that statins be continued in patients already on such treatment at dialysis initiation [7–9].”
Cherska, M., Pavlenko, O., Zlatkina, V. V., Kuts, L., Taraniuk, K., Деміхов, О., Storozhenko, T. Y., Koleva-Tyutyundzhieva, D. I., Kukharchuk, K., Gohary, A. E., et al. (2026) · Ukrainian Journal of Nephrology and Dialysis · doi:10.31450/ukrjnd.1(89).2026.07
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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