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

doi:10.3877/cma.j.issn.2095-3216.2021.06.006

Abstract

Abstract:

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.

Key words: Chronic kidney disease, Lipid-regulating drug, Lipid management, Prognosis

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

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References 39

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指南	患者人群	CKD分期	血脂管理意见
KDIGO	年龄≥50	1~2	他汀类药物
		3~5(透析前)	他汀类药物(可联合依折麦布)
	18~49岁+合并以下1项： 1．CVD(冠心病/心肌梗死/缺血性卒中) 2．糖尿病 3．10年冠脉事件死亡或非致命性心梗的发生率>10%(Framingham风险评分)	1~5(透析前)	他汀类药物
	透析依赖	5	不推荐启动他汀类调脂(2A) 已使用他汀类可考虑继续(2C)
	肾移植术后	1~5(透析前)	他汀类药物
ACC/AHA (2013)	ASCVD	1~5(透析前)	中高剂量他汀类药物
	LDL-C≥ 190 mg/dL	1~5(透析前)	中高剂量他汀类药物
	40~75岁，伴糖尿病或10年期ASCVD风险≥7.5%	1~5(透析前)	中高剂量他汀类药物
ACC/AHA (2018/2019)	ASCVD	1~5(透析前)	他汀类药物(可联合依折麦布/ PCSK9i),实现目标值：LDL-C<1.8 mmol/L(70 mg/dL)或降低50%以上
	LDL-C≥ 190 mg/dL	1~5(透析前)	他汀类药物(可联合依折麦布/ PCSK9i),实现目标值：LDL-C<1.8 mmol/L(70 mg/dL)或降低50%以上
	40~75岁，不合并糖尿病，10年期ASCVD风险≥5%	3~4	他汀类药物，实现目标值：LDL-C降低30%以上
ESC/EAS(2019)	ASCVD高危	3	他汀类药物(可联合依折麦布/ PCSK9i),实现目标值：LDL-C<1.8 mmol/L(70 mg/dL)或降低50%以上
	ASCVD极高危	4~5(透析前)	他汀类药物(可联合依折麦布/ PCSK9i),实现目标值：LDL-C<1.4 mmol/L(55 mg/dL)或降低50%以上

指南	患者人群	CKD分期	血脂管理意见
KDIGO	年龄≥50	1~2	他汀类药物
		3~5(透析前)	他汀类药物(可联合依折麦布)
	18~49岁+合并以下1项： 1．CVD(冠心病/心肌梗死/缺血性卒中) 2．糖尿病 3．10年冠脉事件死亡或非致命性心梗的发生率>10%(Framingham风险评分)	1~5(透析前)	他汀类药物
	透析依赖	5	不推荐启动他汀类调脂(2A) 已使用他汀类可考虑继续(2C)
	肾移植术后	1~5(透析前)	他汀类药物
ACC/AHA (2013)	ASCVD	1~5(透析前)	中高剂量他汀类药物
	LDL-C≥ 190 mg/dL	1~5(透析前)	中高剂量他汀类药物
	40~75岁，伴糖尿病或10年期ASCVD风险≥7.5%	1~5(透析前)	中高剂量他汀类药物
ACC/AHA (2018/2019)	ASCVD	1~5(透析前)	他汀类药物(可联合依折麦布/ PCSK9i),实现目标值：LDL-C<1.8 mmol/L(70 mg/dL)或降低50%以上
	LDL-C≥ 190 mg/dL	1~5(透析前)	他汀类药物(可联合依折麦布/ PCSK9i),实现目标值：LDL-C<1.8 mmol/L(70 mg/dL)或降低50%以上
	40~75岁，不合并糖尿病，10年期ASCVD风险≥5%	3~4	他汀类药物，实现目标值：LDL-C降低30%以上
ESC/EAS(2019)	ASCVD高危	3	他汀类药物(可联合依折麦布/ PCSK9i),实现目标值：LDL-C<1.8 mmol/L(70 mg/dL)或降低50%以上
	ASCVD极高危	4~5(透析前)	他汀类药物(可联合依折麦布/ PCSK9i),实现目标值：LDL-C<1.4 mmol/L(55 mg/dL)或降低50%以上

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