Statins and Chronic Kidney Disease

There is an excellent review of the use of statins is CKD in KI from last month. The authors point out that the association between LDL cholesterol and CVD is not as strong in patients with CKD, particularly in stages IV and V. In fact, the clearer association between hypertriglyceridemia, low HDL and CVD in patients with advanced CKD suggests that statins may not be the best treatment in this setting. The results of clinical trials are conflicting. However, the authors of the current study came up with some suggested guidelines for the management of hyperlipidemia in CKD reproduced below:

1. LDL cholesterol-lowering strategies include either statins or ezetemibe, or both, and target the reduction of LDL to <70 mg/dl as recommended for patients with CVD or an equivalent disorder in the general population
2. Start LDL cholesterol-lowering treatment in stages 1-4 CKD patients with preexisting CV events or those with multiple risk factors and at high risk for coronary heart disease and LDL cholesterol > 70 mg/dl
3. Continue LDL cholesterol-lowering strategies in patients developing CKD stage 1 or more or those starting dialysis who were previously on such treatment
4. Do not use LDL cholesterol-lowering strategies in CKD patients with inflammation/malnutrition, nor start such treatment in dialysis patients who are treatment-naive until additional literature data in favor of a different therapeutic approach become available

What do you think? Do these recommendations make sense?