Tufts University School of Medicine, Boston, MA.
University of Pennsylvania, Philadelphia, PA.
Am J Kidney Dis. 2015 Mar;65(3):354-66. doi: 10.1053/j.ajkd.2014.10.005. Epub 2014 Nov 18.
The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) guideline for management of dyslipidemia in chronic kidney disease (CKD) was published in 2003. Since then, considerable evidence, including randomized controlled trials of statin therapy in adults with CKD, has helped better define medical treatments for dyslipidemia. In light of the new evidence, KDIGO (Kidney Disease: Improving Global Outcomes) formed a work group for the management of dyslipidemia in patients with CKD. This work group developed a new guideline that contains substantial changes from the prior KDOQI guideline. KDIGO recommends treatment of dyslipidemia in patients with CKD primarily based on risk for coronary heart disease, which is driven in large part by age. The KDIGO guideline does not recommend using low-density lipoprotein cholesterol level as a guide for identifying individuals with CKD to be treated or as treatment targets. Initiation of statin treatment is no longer recommended in dialysis patients. To assist US practitioners in interpreting and applying the KDIGO guideline, NKF-KDOQI convened a work group to write a commentary on this guideline. For the most part, our work group agreed with the recommendations of the KDIGO guideline, although we describe several areas in which we believe the guideline statements are either too strong or need to be more nuanced, areas of uncertainty and inconsistency, as well as additional research recommendations. The target audience for the KDIGO guideline includes nephrologists, primary care practitioners, and non-nephrology specialists such as cardiologists and endocrinologists. As such, we also put the current recommendations into the context of other clinical practice recommendations for cholesterol treatment.
美国国家肾脏基金会肾脏病预后质量倡议 (NKF-KDOQI) 于 2003 年发布了慢性肾脏病 (CKD) 血脂异常管理指南。此后，包括 CKD 成人他汀类药物治疗的随机对照试验在内的大量证据，有助于更好地确定血脂异常的治疗方法。有鉴于新的证据，KDIGO（肾脏病：改善全球预后）成立了一个 CKD 患者血脂异常管理工作组。该工作组制定了新的指南，与之前的 KDOQI 指南相比有实质性的变化。KDIGO 建议主要根据发生冠心病的风险来治疗 CKD 患者的血脂异常，而冠心病的风险在很大程度上取决于年龄。KDIGO 指南不建议将低密度脂蛋白胆固醇水平作为识别需要治疗的 CKD 患者的指标或作为治疗目标。不再建议对透析患者启动他汀类药物治疗。为了帮助美国的临床医生解释和应用 KDIGO 指南，NKF-KDOQI 召集了一个工作组，就该指南撰写了一篇评论。在很大程度上，我们的工作组同意 KDIGO 指南的建议，尽管我们描述了几个我们认为指南陈述要么过于强硬，要么需要更细致、存在不确定性和不一致的领域，以及额外的研究建议。KDIGO 指南的目标受众包括肾脏病专家、初级保健医生以及非肾脏病专家，如心脏病专家和内分泌学家。因此，我们还将当前的建议置于其他胆固醇治疗的临床实践建议的背景下。
