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The Benefits of Cholesterol Lowering In Dialysis Patients Is Unproven

November 12th, 2007 | by David Reiner, M.D. |

                               

Elevated cholesterol levels are strongly associated with an increase in coronary heart disease in patient populations with little or no chronic kidney disease.  However, the lack of a clear association between cholesterol levels and mortality among patients on chronic dialysis in the few studies that have investigated this, is unexpected.  This article reviewed prospective studies that looked at the association between total cholesterol and mortality in dialysis patients.

What was found was that there is a negative association at below average cholesterol levels, and a flat or weakly positive association at higher levels of cholesterol.  This is not an expected finding based on the numerous studies that exist showing a strong correlation between cardiac related deaths and elevated cholesterol, but the large majority of these studies excluded dialysis patients. 

The authors suggest that this may be explained by a high proportion of deaths in dialysis patients being due to non-coronary related vascular deaths.  They suggest that further evaluation of the importance of cholesterol levels in dialysis patients can only be done by factoring in multiple other clinical variables that may be more strongly related to mortality.  This study underscores the need for more randomized trials of cholesterol lowering in dialysis patients to determine if they have the same benefit of standard treatments and medicines commonly used in patients without kidney disease.

Reference: Seminars in Dialysis 2007 Nov-Dec;20(6):498-503

Tags: cholesterol, kidney disease