切换至 "中华医学电子期刊资源库"

中华肾病研究电子杂志 ›› 2021, Vol. 10 ›› Issue (06) : 328 -332. doi: 10.3877/cma.j.issn.2095-3216.2021.06.006

综述

慢性肾脏病患者的血脂管理及其对预后的影响
胡继佳1, 丁国华1,()   
  1. 1. 430060 武汉大学人民医院肾内科
  • 收稿日期:2021-07-07 出版日期:2021-12-28
  • 通信作者: 丁国华
  • 基金资助:
    国家自然科学基金面上项目(81770687、81570617)

Lipid management of patients with CKD and its effect on the prognosis

Jijia Hu1, Guohua Ding1,()   

  1. 1. Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
  • Received:2021-07-07 Published:2021-12-28
  • Corresponding author: Guohua Ding
引用本文:

胡继佳, 丁国华. 慢性肾脏病患者的血脂管理及其对预后的影响[J/OL]. 中华肾病研究电子杂志, 2021, 10(06): 328-332.

Jijia Hu, Guohua Ding. Lipid management of patients with CKD and its effect on the prognosis[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2021, 10(06): 328-332.

慢性肾脏病(CKD)患者的血脂异常不仅患病率高,也较一般人群更为复杂,科学的血脂管理有助于减少CKD患者心血管事件等并发症的发生。调脂药物在CKD防治中的应用价值,尤其是对蛋白尿、肾小球滤过率等的影响方面,目前尚存争议。本文对CKD患者的脂代谢特点、血脂管理路径、调脂药物选择及其预后影响等近年来研究结果进行综述,旨在为CKD患者的血脂管理获益最大化提供参考。

The dyslipidemia of patients with chronic kidney disease (CKD) not only has a high prevalence rate, but is also more complicated than the general population. Scientific lipid management can help reduce the occurrence of complications such as cardiovascular events in CKD patients. There is still controversy about the application value of lipid-regulating drugs in the prevention and treatment of CKD, especially in their impact on the proteinuria and glomerular filtration rate, etc. This article reviewed recent research results including the characteristics of lipid metabolism, pathways of lipid management, choice of lipid-regulating drugs, and their effects on the prognosis, aiming to provide a reference for maximizing the benefits of lipid management in CKD patients.

表1 CKD患者不同血脂管理指南内容总结
[1]
王冲,王贵松,李月红. 异常高密度脂蛋白在慢性肾脏病中的研究进展[J]. 中华肾脏病杂志2019, 35(4): 316-320.
[2]
Haynes R, Lewis D, Emberson J, et al. Effects of lowering LDL cholesterol on progression of kidney disease [J]. J Am Soc Nephrol, 2014, 25(8): 1825-1833.
[3]
彭熙,李晓华,马云华,等. 不同类型血脂异常对IgA肾病临床及病理特征的影响[J/CD]. 中华肾病研究电子杂志2016, 5(5): 214-217.
[4]
Wanner C, Tonelli M. KDIGO clinical practice guideline for lipid management in CKD: summary of recommendation statements and clinical approach to the patient [J]. Kidney Int, 2014, 85(6): 1303-1309.
[5]
Mathew RO, Rosenson RS, Lyubarova R, et al. Concepts and controversies: lipid management in patients with chronic kidney disease [J]. Cardiovasc Drugs Ther, 2021, 35(3): 479-489.
[6]
Rahman M, Yang W, Akkina S, et al. Relation of serum lipids and lipoproteins with progression of CKD: the CRIC study [J]. Clin J Am Soc Nephrol, 2014, 9(7): 1190-1198.
[7]
Tsai C, Huang H, Chiang H, et al. Longitudinal lipid trends and adverse outcomes in patients with CKD: a 13-year observational cohort study [J]. J Lipid Res, 2019, 60(3): 648-660.
[8]
Toth PP, Dwyer JP, Cannon CP, et al. Efficacy and safety of lipid lowering by alirocumab in chronic kidney disease [J]. Kidney Int, 2018, 93(6): 1397-1408.
[9]
Catapano AL, Graham I, De Backer G, et al. 2016 ESC/EAS guidelines for the management of dyslipidaemias [J]. Eur Heart J, 2016, 37(39): 2999-3058.
[10]
Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk [J]. Eur Heart J, 2020, 41(1): 111-188.
[11]
Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines [J]. J Am Coll Cardiol, 2014, 63(25 Pt B): 2889-2934.
[12]
Grundy S, Stone N, Bailey A, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APHA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines [J]. Circulation, 2019, 139(25): e1082-e1143.
[13]
Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines [J]. J Am Coll Cardiol, 2019, 74(10): 1376-1414.
[14]
Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk [J]. Eur Heart J, 2020, 41(1): 111-188.
[15]
Jacobson TA, Ito MK, Maki KC, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: part 1—full report [J]. J Clin Lipidol, 2015, 9(2): 129-169.
[16]
Mach F, Ray KK, Wiklund O, et al. Adverse effects of statin therapy: perception vs. the evidence - focus on glucose homeostasis, cognitive, renal and hepatic function, haemorrhagic stroke and cataract [J]. Eur Heart J, 2018, 39(27): 2526-2539.
[17]
杨文领,张现化,闵青,等. 辛伐他汀在终末期肾病患者中的群体药代动力学研究[J]. 中华肾脏病杂志2013, 29(4): 302-303.
[18]
Streja E, Streja DA, Soohoo M, et al. Precision medicine and personalized management of lipoprotein and lipid disorders in chronic and end-stage kidney disease [J]. Semin Nephrol, 2018, 38(4): 369-382.
[19]
Tunon J, Steg PG, Bhatt DL, et al. Effect of alirocumab on major adverse cardiovascular events according to renal function in patients with a recent acute coronary syndrome: prespecified analysis from the ODYSSEY OUTCOMES randomized clinical trial [J]. Eur Heart J, 2020, 41(42): 4114-4123.
[20]
Toth PP, Dwyer JP, Cannon CP, et al. Efficacy and safety of lipid lowering by alirocumab in chronic kidney disease [J]. Kidney Int, 2018, 93(6): 1397-1408.
[21]
Charytan DM, Sabatine MS, Pedersen TR, et al. Efficacy and safety of evolocumab in chronic kidney disease in the FOURIER trial [J]. J Am Coll Cardiol, 2019, 73(23): 2961-2970.
[22]
Boer IH, Zelnick LR, Ruzinski J, et al. Effect of vitamin D and omega-3 fatty acid supplementation on kidney function in patients with type 2 diabetes: a randomized clinical trial [J]. JAMA, 2019, 322(19): 1899-1909.
[23]
Palmer SC, Navaneethan SD, Craig JC, et al. HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis [DB/OL]. Cochrane Database Syst Rev, 2014, 5: CD007784.
[24]
Rivera M, Tamariz L, Suarez M, et al. Modifying effect of statins on fatal outcomes in chronic kidney disease patients in the systolic blood pressure intervention trial: a post hoc analysis [J]. Am J Nephrol, 2019, 49(4): 297-306.
[25]
Su X, Zhang L, Lv J, et al. Effect of statins on kidney disease outcomes: a systematic review and meta-analysis [J]. Am J Kidney Dis, 2016, 67(6): 881-892.
[26]
Sandhu S, Wiebe N, Fried LF, et al. Statins for improving renal outcomes: a meta-analysis [J]. J Am Soc Nephrol, 2006, 17(7): 2006-2016.
[27]
Palmer SC, Navaneethan SD, Craig JC, et al. HMG CoA reductase inhibitors (statins) for dialysis patients [DB/OL]. Cochrane Database Syst Rev, 2013, 9: CD004289.
[28]
Ferro CJ, Mark PB, Kanbay M, et al. Lipid management in patients with chronic kidney disease [J]. Nat Rev Nephrol, 2018, 14(12): 727-749.
[29]
Chung CM, Lin MS, Chang CH, et al. Moderate to high intensity statin in dialysis patients after acute myocardial infarction: a national cohort study in Asia [J]. Atherosclerosis, 2017, 267: 158-166.
[30]
Ota Y, Kitamura M, Muta K, et al. Effect of statin on life prognosis in Japanese patients undergoing hemodialysis [J]. PLoS One, 2019, 14(10): e0224111.
[31]
Krane V, Schmidt KR, Gutjahr-Lengsfeld LJ, et al. Long-term effects following 4 years of randomized treatment with atorvastatin in patients with type 2?diabetes mellitus on hemodialysis [J]. Kidney Int, 2016, 89(6): 1380-1387.
[32]
Park CH, Kang EW, Park JT, et al. Association of serum lipid levels over time with survival in incident peritoneal dialysis patients [J]. J Clin Lipidol, 2017, 11(4): 945-954.
[33]
Genser B, Wanner C, März W. A scoring system for predicting individual treatment effects of statins in type 2 diabetes patients on haemodialysis [J]. Eur J Prev Cardiol, 2021, 28(8): 838-851.
[34]
Nakamura H, Arakawa K, Itakura H, et al. Primary prevention of cardiovascular disease with pravastatin in Japan (MEGA study): a prospective randomised controlled trial [J]. Lancet, 2006, 368(9542): 1155-1163.
[35]
Shen H, Chen X, Lu J, et al. Effects of statin therapy on chronic kidney disease patients with coronary artery disease [J]. Lipids Health Dis, 2018, 17(1): 84.
[36]
Singh M, Mcevoy JW, Khan SU, et al. Comparison of transatlantic approaches to lipid management: the AHA/ACC/multisociety guidelines vs the ESC/EAS guidelines [J]. Mayo Clin Proc, 2020, 95(5): 998-1014.
[37]
de Zeeuw D, Anzalone DA, Cain VA, et al. Renal effects of atorvastatin and rosuvastatin in patients with diabetes who have progressive renal disease (PLANET I): a randomised clinical trial [J]. Lancet Diabetes Endocrinol, 2015, 3(3): 181-190.
[38]
Idzerda MA, Pena MJ, Parving HH, et al. Proteinuria and cholesterol reduction are independently associated with less renal function decline in statin-treated patients; a post hoc analysis of the PLANET trials [J]. Nephrol Dial Transplant, 2019, 34(10): 1699-1706.
[39]
Fiedler R, Jehle PM, Osten B, et al. Clinical nutrition scores are superior for the prognosis of haemodialysis patients compared to lab markers and bioelectrical impedance [J]. Nephrol Dial Transplant, 2009, 24(12): 3812-3817.
[1] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[2] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[3] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[4] 屈翔宇, 张懿刚, 李浩令, 邱天, 谈燚. USP24及其共表达肿瘤代谢基因在肝细胞癌中的诊断和预后预测作用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 659-662.
[5] 顾雯, 凌守鑫, 唐海利, 甘雪梅. 两种不同手术入路在甲状腺乳头状癌患者开放性根治性术中的应用比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 687-690.
[6] 付成旺, 杨大刚, 王榕, 李福堂. 营养与炎症指标在可切除胰腺癌中的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 704-708.
[7] 李伟, 宋子健, 赖衍成, 周睿, 吴涵, 邓龙昕, 陈锐. 人工智能应用于前列腺癌患者预后预测的研究现状及展望[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 541-546.
[8] 陈樽, 王平, 金华, 周美玲, 李青青, 黄永刚. 肌肉减少症预测结直肠癌术后切口疝发生的应用研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 639-644.
[9] 关小玲, 周文营, 陈洪平. PTAAR在乙肝相关慢加急性肝衰竭患者短期预后中的预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 841-845.
[10] 张润锦, 阳盼, 林燕斯, 刘尊龙, 刘建平, 金小岩. EB病毒相关胆管癌伴多发转移一例及国内文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 865-869.
[11] 陈晓鹏, 王佳妮, 练庆海, 杨九妹. 肝细胞癌VOPP1表达及其与预后的关系[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 876-882.
[12] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[13] 程柏凯, 杨光. 高胰岛素-正葡萄糖钳夹技术评估慢性肾脏病患者胰岛素抵抗的研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(06): 334-339.
[14] 董佳, 王坤, 张莉. 预后营养指数结合免疫球蛋白、血糖及甲胎蛋白对HBV 相关慢加急性肝衰竭患者治疗后预后不良的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 555-559.
[15] 王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
阅读次数
全文


摘要