Statin therapy in childhood and adult chronic kidney disease: from controversies to consensus

Abstract

Background: Pediatric and adult chronic kidney disease (CKD) constitute a global health burden. Cardiovascular disease (CVD) is the major cause of mortality in CKD. As a well-established risk factor for CVD in the general population , dyslipidemia also occurs in CKD patients. The dyslipidemia in CKD is essentially due to elevated triglyceride levels, reduced high density lipoprotein-cholesterol (HDL-C) and varying levels of low density lipoprotein-cholesterol (LDL-C). Although hypolipidemic drugs, especially statins, have been successfully tried in adult and childhood CKD to lower LDL-C and prevent CVD risk as well as progression of CKD, their use was initially controversial.

Methodology: The present review aims to discuss the controversies about the use of statin monotherapy in adult and childhood CKD, as well as to highlight the current indications for their use in the disease.

Results: The current consensus on the use of statins in adult CKD management is that the drugs are more beneficial in the early stages of CKD than in end-stage renal disease (ESRD) or hemodialysis patients. In addition, they are recommended in renal transplant recipients and in younger patients with CKD who are at high risk for CVD. More importantly, statin therapy has now been proven to be useful and safe in pediatric CKD such as steroid-resistant nephrotic syndrome and autosomal dominant polycystic kidney disease (ADPKD).

Conclusion: Despite the evidencebased efficacy and safety of statins in pediatric and adult CKD, drug trials of longer duration have been advocated in order to validate their efficacy and establish their safety in the long term.

Keywords: Chronic kidney disease, dyslipidemia, cardiovascular disease, statin