Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Review Kidney Blood Press Res 2010;33:100–110 DOI: 10.1159/000302712 Alterations of Lipid Metabolism in Chronic Nephropathies: Mechanisms, Diagnosis and Treatment Antonio Lacquaniti Davide Bolignano Valentina Donato Caterina Bono Maria Rosaria Fazio Michele Buemi Section of Nephrology, Department of Internal Medicine, University of Messina, Messina, Italy Introduction Cardiovascular disease (CVD) represents the main cause of death in patients with end-stage renal disease. The risk for coronaropathy is higher in patients with re- nal impairment than in the general population and this evidence cannot be exclusively due to the ‘traditional’ risk factors. The link between dyslipidemia and increased CVD risk in patients with chronic kidney disease (CKD) has been difficult to define, mainly due to the coexistence of several cardiovascular risk factors in patients with CKD, including increased oxidative stress, inflammation, physical inactivity, anemia, vascular calcification, endo- thelial dysfunction, and reduced nitric oxide availabil- ity. The atherogenic potential of dyslipidemia in kidney disease may depend more on apolipoproteins than on lip- id abnormalities, and may not always be recognized by measurement of plasma lipids alone [1, 2]. This review focuses on dyslipidemias as they occur in patients with chronic nephropathy, describing their causes and their effects on the cardiovascular system. We also reviewed the clinical evidence and recommenda- tions for the use of lipid-regulating drugs in patients with CKD, nephrotic syndrome (NS), those undergoing hemo- and peritoneal dialysis, and in transplanted patients. Key Words Lipid metabolism  Nephropathy  Cardiovascular disease  Atherosclerosis  Dyslipidemia Abstract Nephropathic subjects show an increased tendency to de- velop cardiovascular diseases, mainly as the consequence of several risk factors including increased oxidative stress, inflammation, physical inactivity, anemia, vascular calcifica- tion, and endothelial dysfunction. The alterations in lipid metabolism represent a relatively lesser important cause of genesis and progression of atherosclerosis. Unfortunately, in these patients the atherogenic potential of dyslipidemia may depend more on apolipoproteins than on lipid abnor- malities, and may not always be recognized by measure- ment of plasma lipids alone. The aim of this review was there- fore to analyze the main lipid alterations that can occur in nephropathic patients, as well as their causes and their ef- fects on the cardiovascular system. The clinical evidence and recommendations for the use of lipid-regulating drugs in pa- tients with chronic kidney disease, nephrotic syndrome, in patients undergoing hemo- and peritoneal dialysis and in transplanted patients was also reviewed. Moreover, we ana- lyzed the link between dyslipidemia and kidney disease on- set and progression and the role of statins in preventing it. Copyright © 2010 S. Karger AG, Basel Published online: March 27, 2010 Prof. Michele Buemi Via Salita Villa Contino, 30 IT–98100 Messina (Italy) Tel. +39 090 221 2265, Fax +39 090 293 5162 E-Mail buemim  @  unime.it © 2010 S. Karger AG, Basel 1420–4096/10/0332–0100$26.00/0 Accessible online at: www.karger.com/kbr