Ozsoy Riza C, van Leuven Sander I, Kastelein John J P, Arisz Lambertus, Koopman Marion G
Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Curr Opin Lipidol. 2006 Dec;17(6):659-66. doi: 10.1097/MOL.0b013e328010a87d.
Dyslipidemia is a prevalent condition in patients with chronic renal disease, but is often left untreated. Statin treatment constitutes an effective way to improve lipid abnormalities. This review summarizes present studies on dyslipidemia and its treatment in patients with chronic renal disease.
The specific dyslipidemia in renal disease is associated with the presence of proteinuria and decreased creatinine clearance, and may even adversely affect the progression of chronic renal disease. Statin therapy may have renoprotective effects due to a combination of lipid lowering and pleiotropic effects. Statins exert several anti-inflammatory properties and lead to a decrease of proteinuria. Post-hoc analyses of large-scale lipid lowering trials have shown that the reduction of cardiovascular risk was equivalent to the reduction achieved in patients without chronic renal failure. We feel, however, that if intervention with statins is postponed until patients reach end-stage renal disease, statins have limited benefit.
Present studies suggest that patients with renal disease should be screened early for dyslipidemia and that statins have to be considered as the lipid lowering therapy of choice. These drugs reduce cardiovascular risk. Further studies are needed to firmly establish whether statins preserve renal function.
血脂异常在慢性肾病患者中很常见，但往往未得到治疗。他汀类药物治疗是改善脂质异常的有效方法。本综述总结了目前关于慢性肾病患者血脂异常及其治疗的研究。
肾病中的特定血脂异常与蛋白尿的存在和肌酐清除率降低有关，甚至可能对慢性肾病的进展产生不利影响。他汀类药物治疗可能因降脂和多效性作用的结合而具有肾脏保护作用。他汀类药物具有多种抗炎特性，并可导致蛋白尿减少。大规模降脂试验的事后分析表明，心血管风险的降低与无慢性肾衰竭患者所达到的降低程度相当。然而，我们认为，如果将他汀类药物的干预推迟到患者达到终末期肾病，他汀类药物的益处有限。
目前的研究表明，肾病患者应尽早筛查血脂异常，他汀类药物应被视为降脂治疗的首选药物。这些药物可降低心血管风险。需要进一步研究以确定他汀类药物是否能保护肾功能。
