Department of Renal Medicine, University Hospitals Birmingham, Edgbaston, Birmingham, UK.
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Nat Rev Nephrol. 2018 Dec;14(12):727-749. doi: 10.1038/s41581-018-0072-9.
An increased risk of cardiovascular disease, independent of conventional risk factors, is present even at minor levels of renal impairment and is highest in patients with end-stage renal disease (ESRD) requiring dialysis. Renal dysfunction changes the level, composition and quality of blood lipids in favour of a more atherogenic profile. Patients with advanced chronic kidney disease (CKD) or ESRD have a characteristic lipid pattern of hypertriglyceridaemia and low HDL cholesterol levels but normal LDL cholesterol levels. In the general population, a clear relationship exists between LDL cholesterol and major atherosclerotic events. However, in patients with ESRD, LDL cholesterol shows a negative association with these outcomes at below average LDL cholesterol levels and a flat or weakly positive association with mortality at higher LDL cholesterol levels. Overall, the available data suggest that lowering of LDL cholesterol is beneficial for prevention of major atherosclerotic events in patients with CKD and in kidney transplant recipients but is not beneficial in patients requiring dialysis. The 2013 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Lipid Management in CKD provides simple recommendations for the management of dyslipidaemia in patients with CKD and ESRD. However, emerging data and novel lipid-lowering therapies warrant some reappraisal of these recommendations.
即使在轻度肾功能损害的情况下，也存在心血管疾病风险增加的情况，且这种风险独立于传统风险因素，在需要透析的终末期肾病（ESRD）患者中最高。肾功能障碍会改变血脂的水平、组成和质量，使其更有利于动脉粥样硬化。晚期慢性肾脏病（CKD）或 ESRD 患者具有高甘油三酯血症和低 HDL 胆固醇水平但 LDL 胆固醇水平正常的特征性脂质模式。在一般人群中，LDL 胆固醇与主要动脉粥样硬化事件之间存在明确的关系。然而，在 ESRD 患者中，LDL 胆固醇在 LDL 胆固醇水平低于平均水平时与这些结果呈负相关，而在 LDL 胆固醇水平较高时与死亡率呈平坦或弱阳性相关。总体而言，现有数据表明，降低 LDL 胆固醇可预防 CKD 患者和肾移植受者的主要动脉粥样硬化事件，但对需要透析的患者则没有益处。2013 年肾脏病：改善全球结果（KDIGO）脂质管理临床实践指南为 CKD 和 ESRD 患者的血脂异常管理提供了简单的建议。然而，新出现的数据和新型降脂治疗方法需要重新评估这些建议。
