Review of Current Guidelines: National Cholesterol Education Program and Kidney Disease Outcomes Quality Initiative as They Apply to CKD with Dyslipidemias

Abstract

After the third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel, ATP III), there has been a much progress and reduction in prevalence of high blood cholesterol in the United States. However, in ATP III, without excluding or including patients with chronic kidney disease (CKD), there are few specific recommendations for the evaluation and treatment of dyslipidemias in CKD. Besides, the NCEP guidelines are applicable to patients with stages 1–4 CKD and not specifically concerned with Stage 5 CKD and kidney transplant recipients. It is also evident that when these guidelines were published, there were no large randomized controlled trials evaluating the effects of lipid-lowering therapy in this patient group. Given the recommendations of the National Kidney Foundation Task Force on Cardiovascular Disease in Chronic Renal Disease that patients with CKD should be considered in the highest risk group for cardiovascular disease, it was decided that specific recommendations should be applied to patients with CKD. Thus, from the outset of Kidney Disease Outcomes Quality Initiative (K/DOQI), it was strongly agreed that management of dyslipidemias in patients with kidney disease would be one of the most important issues. However, recent randomized controlled trials showed that dyslipidemia treatment in these patients had shown modest benefit at best with regard to cardiovascular mortality. Thus, in this chapter the specific recommendations about dyslipidemias in CKD patients are reviewed based on NCEP and KDOQI guidelines along with the new studies and future perspectives.