Therapeutic Considerations for the Use of Statin Therapy in Chronic Renal Disease

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

This review presents an evidence-based analysis of the use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) in patients with chronic renal disease. It considers the characteristics and incidence of dyslipidaemia among specific patient types and describes the available data concerning the ability of statin therapy to regulate dyslipidaemia in the renal disease population as well as early results for an anti-inflammatory effect in this group. The clinical impact of statins in terms of reduced morbidity and mortality is also discussed. The relative merits of different statin agents are reviewed in terms of efficacy and safety, together with the role of aggressive intervention as compared with standard approaches to care. Finally, a proposed algorithm for the initiation and monitoring of statin therapy in chronic renal disease patients is presented.

Related collections

Most cited references 14

Record: found
Abstract: found
Article: not found

The elephant in uremia: oxidant stress as a unifying concept of cardiovascular disease in uremia.

Jonathan Himmelfarb, Peter Stenvinkel, T Alp Ikizler … (2002)

Cardiovascular disease is the leading cause of mortality in uremic patients. In large cross-sectional studies of dialysis patients, traditional cardiovascular risk factors such as hypertension and hypercholesterolemia have been found to have low predictive power, while markers of inflammation and malnutrition are highly correlated with cardiovascular mortality. However, the pathophysiology of the disease process that links uremia, inflammation, and malnutrition with increased cardiovascular complications is not well understood. We hereby propose the hypothesis that increased oxidative stress and its sequalae is a major contributor to increased atherosclerosis and cardiovascular morbidity and mortality found in uremia. This hypothesis is based on studies that conclusively demonstrate an increased oxidative burden in uremic patients, before and particularly after renal replacement therapies, as evidenced by higher concentrations of multiple biomarkers of oxidative stress. This hypothesis also provides a framework to explain the link that activated phagocytes provide between oxidative stress and inflammation (from infectious and non-infections causes) and the synergistic role that malnutrition (as reflected by low concentrations of albumin and/or antioxidants) contributes to the increased burden of cardiovascular disease in uremia. We further propose that retained uremic solutes such as beta-2 microglobulin, advanced glycosylated end products (AGE), cysteine, and homocysteine, which are substrates for oxidative injury, further contribute to the pro-atherogenic milieu of uremia. Dialytic therapy, which acts to reduce the concentration of oxidized substrates, improves the redox balance. However, processes related to dialytic therapy, such as the prolonged use of catheters for vascular access and the use of bioincompatible dialysis membranes, can contribute to a pro-inflammatory and pro-oxidative state and thus to a pro-atherogenic state. Anti-oxidative therapeutic strategies for patients with uremia are in their very early stages; nonetheless, early studies demonstrate the potential for significant efficacy in reducing cardiovascular complications.

0 comments Cited 300 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: not found
Article: not found

Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S)

SCANDINAVIANSIMVASTATINSURVIVAL (1994)

0 comments Cited 298 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: not found
Article: not found

Effect of Statin Therapy on C-Reactive Protein Levels

Michelle A Albert, Ellie Danielson, Nader Rifai … (2001)

0 comments Cited 94 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (publisher-id): NEC

Journal ID (nlm-ta): Nephron Clin Pract

Journal ID (doi): 10.1159/issn.1660-2110

Title: Nephron Clinical Practice

Publisher: S. Karger AG

ISSN (Electronic): 1660-2110

Publication date Subscription-year: 2003

Publication date (Print): December 2003

Publication date (Electronic): 17 November 2004

Volume: 95

Issue: 4

Pages: c107-c115

Affiliations

Renal Unit, University Hospital of Wales, Cardiff, UK

Article

Publisher ID: 74835 Other ID: Nephron Clin Pract 2003;95:c107–c115

DOI: 10.1159/000074835

PubMed ID: 14694271

SO-VID: 8b13e308-497b-4fcd-8de9-862a1f9f0d9a

License:

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Call for Papers: Green Renal Replacement Therapy: Caring for the Environment

Submit here before September 30, 2024

Therapeutic Considerations for the Use of Statin Therapy in Chronic Renal Disease

Read this article at

Abstract

Related collections

Karger: Nephrology

Most cited references 14

The elephant in uremia: oxidant stress as a unifying concept of cardiovascular disease in uremia.

Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S)

Effect of Statin Therapy on C-Reactive Protein Levels

Author and article information

Journal

Affiliations

Article

History

Page count

Categories

Comments

Comment on this article

Similar content 561

Most referenced authors 572