Chronic kidney disease (CKD), which affects >10% of the population worldwide, is associated with a dramatically increased rate of cardiovascular disease (CVD). More people with CKD will die from CVD than develop end-stage renal disease with dialysis-dependency. However, the contribution of classical atherosclerotic cardiovascular risk factors is less evident than in the general population. Particularly, the relationship between dyslipidemia and CVD morbidity and mortality in CKD patients is not as evident as in the general population. While LDL cholesterol-lowering drugs such as statins significantly reduce the rate of cardiovascular events in the general population, their role in patients with end-stage renal disease has been questioned. This could be caused by a shift from atherosclerotic to non-atherosclerotic CVD in patients with advanced CKD, which cannot be effectively prevented by lipid-lowering drugs. In addition, many lines of evidence suggest that impaired renal function directly affects the metabolism, composition and functionality of lipoproteins, which may affect their responsiveness to pharmacological interventions. In this review, we highlight the challenges for the therapeutic application of lipid-lowering treatment strategies in CKD and discuss why treatment strategies used in the general population cannot be applied uncritically to CKD patients.

中文翻译：

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慢性肾脏病的调脂治疗：病理生理学和临床考虑。

慢性肾病 (CKD) 影响全球 10% 以上的人口，与心血管疾病 (CVD) 发病率显着增加有关。与依赖透析的终末期肾病相比，患有 CKD 的人死于 CVD 的人数更多。然而，经典动脉粥样硬化性心血管危险因素的贡献不如一般人群明显。特别是，CKD 患者血脂异常与 CVD 发病率和死亡率之间的关系并不像一般人群那样明显。虽然他汀类药物等 LDL 降胆固醇药物可显着降低普通人群的心血管事件发生率，但它们在终末期肾病患者中的作用一直受到质疑。这可能是由于晚期 CKD 患者从动脉粥样硬化性 CVD 向非动脉粥样硬化性 CVD 转变所致，降脂药物无法有效预防。此外，许多证据表明，肾功能受损直接影响脂蛋白的代谢、组成和功能，这可能会影响它们对药物干预的反应。在这篇综述中，我们强调了降脂治疗策略在 CKD 中的治疗应用所面临的挑战，并讨论了为什么在一般人群中使用的治疗策略不能不加批判地应用于 CKD 患者。这可能会影响他们对药物干预的反应。在这篇综述中，我们强调了降脂治疗策略在 CKD 中的治疗应用所面临的挑战，并讨论了为什么在一般人群中使用的治疗策略不能不加批判地应用于 CKD 患者。这可能会影响他们对药物干预的反应。在这篇综述中，我们强调了降脂治疗策略在 CKD 中的治疗应用所面临的挑战，并讨论了为什么在一般人群中使用的治疗策略不能不加批判地应用于 CKD 患者。