Peripheral arterial disease (PAD) results in significant morbidity and mortality in patients with kidney failure.[1,2] The traditional risk factors for PAD in the general population include age, gender, diabetes mellitus (DM), hyperlipidemia (HL), hypertension and smoking. In patients with kidney failure, there may be additional interplay, such as elevated homocysteine levels,[3] with vascular calcification from chronic inflammation and mineral bone disease.[4] Currently, statin therapy is recommended in patients with PAD,[5] and there exist ample data to demonstrate lipid-lowering by statins to confer cardiovascular (CV) protection. Robust clinical trials in the general population have provided irrefutable evidence for statin therapy in both primary[6,7] and secondary prevention.[8,9] However, CV benefits were not observed in major clinical trials attesting statin therapy in kidney failure cohorts.[10–12] In the Study of Heart and Renal Protection (SHARP),[10] for example, though a fixed dose of simvastatin and ezetimibe among >6000 predialysis CKD subjects and >3000 dialysis patients resulted in a 17% reduction in atherosclerotic events, as compared with placebo, the clear benefit in event reduction observed in predialysis patients was lost in patients on dialysis.
Based on these data, the 2013 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for Lipid Management has thus not advocated follow-up measurement of lipid levels for the majority of dialysis patients nor the initiation of statin therapy in prevalent dialysis patients.
