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Vol. 29. Issue 1.
Pages 22-35 (January - February 2017)
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Vol. 29. Issue 1.
Pages 22-35 (January - February 2017)
Review article
DOI: 10.1016/j.artere.2016.04.001
Chronic kidney disease and dyslipidaemia
Enfermedad renal crónica y dislipidemia
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V. Pascuala,
Corresponding author
pascual_vic@gva.es

Corresponding author.
, A. Serranob, J. Pedro-Botetc, J. Ascasod, V. Barriose, J. Millánf, X. Pintóg, A. Casesh
a Centro de Salud Palleter, Castellón, Spain
b Centro de Salud de Repelega, Osakidetza, Portugalete, Bizkaia, Spain
c Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
d Servicio de Endocrinología, Hospital Clínico Universitario, Universitat de València, Valencia, Spain
e Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá de Henares, Madrid, Spain
f Unidad de Lípidos, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, Universitat de Barcelona, CIBERobn-ISCIII, Barcelona, Spain
g Servicio de Medicina Interna, Hospital Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
h Servicio de Nefrología, Hospital Clínic, Universitat de Barcelona, Red de Investigación Cardiovascular (RIC), Barcelona, Spain
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Figures (1)
Tables (7)
Table 1. Cardiovascular risk in chronic kidney disease according to estimated glomerular filtration (GFR) category and albuminuria.
Table 2. Recommended LDL-C control targets in chronic kidney disease patients by various cardiovascular risk categories.
Table 3. Cardiovascular risk factors in chronic kidney disease.
Table 4. Primary characteristics of lipid alterations in chronic kidney disease.
Table 5. Changes in lipid profile in different chronic kidney disease stages.
Table 6. Daily doses of statins and other lipid-lowering medications for managing dyslipidaemia in chronic kidney disease.
Table 7. Lipid-lowering medications in chronic kidney disease.
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Abstract

Chronic kidney disease (CKD) has to be considered as a high, or even very high risk cardiovascular risk condition, since it leads to an increase in cardiovascular mortality that continues to increase as the disease progresses.

An early diagnosis of CKD is required, together with an adequate identification of the risk factors, in order to slow down its progression to more severe states, prevent complications, and to delay, whenever possible, the need for renal replacement therapy.

Dyslipidaemia is a factor of the progression of CKD that increases the risk in developing atherosclerosis and its complications. Its proper control contributes to reducing the elevated cardiovascular morbidity and mortality presented by these patients.

In this review, an assessment is made of the lipid-lowering therapeutic measures required to achieve to recommended objectives, by adjusting the treatment to the progression of the disease and to the characteristics of the patient.

In CKD, it seems that an early and intensive intervention of the dyslipidaemia is a priority before there is a significant decrease in kidney function. Treatment with statins has been shown to be safe and effective in decreasing LDL-cholesterol, and in the reduction of cardiovascular events in individuals with CKD, or after renal transplant, although there is less evidence in the case of dialysed patients.

Keywords:
Chronic kidney disease
Dyslipidemia
Statins
Resumen

La enfermedad renal crónica (ERC) ha de ser considerada como una situación de alto e incluso muy alto riesgo cardiovascular, ya que provoca un aumento de la mortalidad cardiovascular que va incrementándose a medida que progresa la enfermedad.

Es preciso realizar un diagnóstico precoz de la ERC junto con la adecuada identificación de los factores de riesgo, al objeto de frenar su evolución a estadios más severos, evitar las complicaciones y retrasar, en lo posible, la necesidad de tratamiento sustitutivo renal.

La dislipidemia es un factor de progresión de la ERC que aumenta el riesgo de desarrollo de aterosclerosis y sus complicaciones. Su adecuado control contribuye a reducir la elevada morbimortalidad cardiovascular que presentan estos pacientes.

En esta revisión se evalúan las medidas terapéuticas hipolipemiantes necesarias para el logro de los objetivos recomendados, ajustando el tratamiento a la evolución de la enfermedad y a las características del paciente.

En la ERC parece prioritaria una intervención precoz e intensiva de la dislipidemia antes de que se produzca una disminución importante de la función renal. El tratamiento con estatinas ha demostrado ser seguro y eficaz en la disminución del cLDL y en la reducción de episodios cardiovasculares en individuos con ERC o después del trasplante renal; sin embargo, la evidencia en los pacientes dializados es menor.

Palabras clave:
Enfermedad renal crónica
Dislipidemia
Estatinas

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