Dyslipidemia and lipid-lowering therapy in patients on renal replacement therapy: a literature review
https://doi.org/10.15825/1995-1191-2025-4-158-172
Abstract
Dyslipidemia in patients with chronic kidney disease (CKD), particularly those on renal replacement therapy (RRT), is a major risk factor for cardiovascular complications. The pathogenesis of lipid metabolism disorders in this population is multifactorial and infl uenced by the underlying kidney disease, the specific characteristics of RRT, and, in transplant recipients, the effects of immunosuppressive therapy. Despite the high prevalence and clinical significance of dyslipidemia in CKD, therapeutic strategies for its correction remain insuffi ciently studied. This review analyzes current pharmacologic approaches to the management of dyslipidemia and evaluates the potential for their application in patients receiving RRT. Literature search was conducted using electronic databases Medline/PubMed (https://pubmed.ncbi.nlm.nih.gov) and eLIBRARY/Russian Science Citation Index (https://www.elibrary.ru).
About the Authors
A. V. Samburov
Volzhsky Branch of Shumakov National Medical Research Center of Transplantology and Artificial Organs
Russian Federation
Russian Federation
Andrey Samburov
Address: 86/1, Karbysheva str., Volgograd, 404133
N. A. Khaibulina
Volzhsky Branch of Shumakov National Medical Research Center of Transplantology and Artificial Organs
Volzhsky
T. L. Kulik
Volzhsky Branch of Shumakov National Medical Research Center of Transplantology and Artificial Organs
Volzhsky
Sh. R. Galeev
Volzhsky Branch of Shumakov National Medical Research Center of Transplantology and Artificial Organs
Volzhsky
References
1. Del Vecchio L, Baragetti I, Locatelli F. New agents to reduce cholesterol levels: implications for nephrologists. Nephrol Dial Transplant. 2020 Feb 1; 35 (2): 213–218. doi: 10.1093/ndt/gfz013. PMID: 30753594.
2. Ndumele CE, Rangaswami J, Chow SL, Neeland IJ, Tuttle KR, Khan SS et al. Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association. Circulation. 2023 Nov 14; 148 (20): 1606–1635. doi: 10.1161/CIR.0000000000001184. PMID: 37807924.
3. Shutov EV, Nikolaev AYu, Filatova NN. Сardiorenal syndrome in patients on renal replacement therapy (A review). Nephrology and Dialysis. 2018; 20 (3): 262–273. [In Russ, English abstract]. doi: 10.28996/2618-9801-2018-3-262-273.
4. Lacount S, Tannock LR, Feingold KR, Ahmed SF, Anawalt B, Blackman MR et al. Dyslipidemia in Chronic Kidney Disease. 2025. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000. PMID: 26247091.
5. Multiple Risk Factor Intervention Trial. Risk factor changes and mortality results. Multiple Risk Factor Intervention Trial Research Group. JAMA. 1997 Feb 19; 277 (7): 582–594. PMID: 9032168.
6. Dawber TR, Kannel WB, Revotskie N, Kagan A. The epidemiology of coronary heart disease – the Framingham enquiry. Proc R Soc Med. 1962 Apr; 55 (4): 265–271. doi: 10.1177/003591576205500403. PMID: 13884013.
7. Kannel WB, Castelli WP, Gordon T. Cholesterol in the prediction of atherosclerotic disease. New perspectives based on the Framingham study. Ann Intern Med. 1979 Jan; 90 (1): 85–91. doi: 10.7326/0003-4819-90-1-85. PMID: 217290.
8. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L et al. ESC Scientific Document Group. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020 Jan 1; 41 (1): 111–188. doi: 10.1093/eurheartj/ehz455. Erratum in: Eur Heart J. 2020 Nov 21; 41 (44): 4255. doi: 10.1093/eurheartj/ehz826. PMID: 31504418.
9. Noels H, Lehrke M, Vanholder R, Jankowski J. Lipoproteins and fatty acids in chronic kidney disease: molecular and metabolic alterations. Nat Rev Nephrol. 2021 Aug; 17 (8): 528–542. doi: 10.1038/s41581-021-00423-5. PMID: 33972752.
10. Harlacher E, Wollenhaupt J, Baaten CCFMJ, Noels H. Impact of Uremic Toxins on Endothelial Dysfunction in Chronic Kidney Disease: A Systematic Review. Int J Mol Sci. 2022 Jan 4; 23 (1): 531. doi: 10.3390/ijms23010531. PMID: 35008960.
11. Rysz J, Franczyk B, Ławiński J, Gluba-Brzózka A. Oxidative Stress in ESRD Patients on Dialysis and the Risk of Cardiovascular Diseases. Antioxidants (Basel). 2020 Nov 3; 9 (11): 1079. doi: 10.3390/antiox9111079. PMID: 33153174.
12. Suh SH, Kim SW. Dyslipidemia in Patients with Chronic Kidney Disease: An Updated Overview. Diabetes Metab J. 2023 Sep; 47 (5): 612–629. doi: 10.4093/dmj.2023.0067. Epub 2023 Jul 24. PMID: 37482655.
13. Cao H, Meng X. HDL and Kidney Diseases. Adv Exp Med Biol. 2022; 1377: 163–170. doi: 10.1007/978-98119-1592-5_13. PMID: 35575929.
14. Gusev E, Sarapultsev A. Atherosclerosis and Inflammation: Insights from the Theory of General Pathological Processes. Int J Mol Sci. 2023 Apr 26; 24 (9): 7910. doi: 10.3390/ijms24097910. PMID: 37175617.
15. Marsche G, Heine GH, Stadler JT, Holzer M. Current Understanding of the Relationship of HDL Composition, Structure and Function to Their Cardioprotective Properties in Chronic Kidney Disease. Biomolecules. 2020 Sep 21; 10 (9): 1348. doi: 10.3390/biom10091348. PMID: 32967334.
16. Speer T, Ridker PM, von Eckardstein A, Schunk SJ, Fliser D. Lipoproteins in chronic kidney disease: from bench to bedside. Eur Heart J. 2021 Jun 7; 42 (22): 2170–2185. doi: 10.1093/eurheartj/ehaa1050. PMID: 33393990.
17. Carty JR, Anastasopoulou C. Lecithin-Cholesterol Acyltransferase Deficiency. 2024. In: StatPearls [Internet]. Treasure Island (FL): StatPearls. PMID: 38753926.
18. Ferro CJ, Mark PB, Kanbay M, Sarafidis P, Heine GH, Rossignol P et al. Lipid management in patients with chronic kidney disease. Nat Rev Nephrol. 2018 Dec; 14 (12): 727–749. doi: 10.1038/s41581-018-0072-9. PMID: 30361677.
19. Lampsas S, Xenou M, Oikonomou E, Pantelidis P, Lysandrou A, Sarantos S et al. Lipoprotein(a) in Atherosclerotic Diseases: From Pathophysiology to Diagnosis and Treatment. Molecules. 2023 Jan 18; 28 (3): 969. doi: 10.3390/molecules28030969. PMID: 36770634.
20. Ma Z, Zhong J, Tu W, Li S, Chen J. The functions of apolipoproteins and lipoproteins in health and disease. Mol Biomed. 2024 Oct 28; 5 (1): 53. doi: 10.1186/s43556024-00218-7. PMID: 39465476.
21. Ren X, Zhang Z, Yan Z. Association Between Lipoprotein (A) and Diabetic Nephropathy in Patients With Type 2 Diabetes Mellitus: A Meta-Analysis. Front Endocrinol (Lausanne). 2021 Mar 24; 12: 633529. doi: 10.3389/fendo.2021.633529. PMID: 33841331.
22. Enkhmaa B, Berglund L. Non-genetic influences on lipoprotein(a) concentrations. Atherosclerosis. 2022 May; 349: 53–62. doi: 10.1016/j.atherosclerosis.2022.04.006. PMID: 35606076.
23. Guarnieri G, Zanetti M, Vinci P, Cattin MR, Barazzoni R. Insulin resistance in chronic uremia. J Ren Nutr. 2009 Jan; 19 (1): 20–24. doi: 10.1053/j.jrn.2008.11.014. PMID: 19121765.
24. Freeman AM, Acevedo LA, Pennings N. Insulin Resistance. 2023 Aug 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. PMID: 29939616.
25. Stegmayr B, Zuo L, Zadora W. Lipid and Bone Effects of Heparin Use During Hemodialysis. Semin Nephrol. 2023 Nov; 43 (6): 151480. doi: 10.1016/j.semnephrol.2023.151480. PMID: 38195305.
26. Zhu S, Zhang F, Shen AW, Sun B, Xia TY, Chen WS et al. Metabolomics Evaluation of Patients With Stage 5 Chronic Kidney Disease Before Dialysis, Maintenance Hemodialysis, and Peritoneal Dialysis. Front Physiol. 2021 Jan 20; 11: 630646. doi: 10.3389/fphys.2020.630646. PMID: 33551851.
27. Liakopoulos V, Roumeliotis S, Zarogiannis S, Eleftheriadis T, Mertens PR. Oxidative stress in hemodialysis: Causative mechanisms, clinical implications, and possible therapeutic interventions. Semin Dial. 2019 Jan; 32 (1): 58–71. doi: 10.1111/sdi.12745. PMID: 30288786.
28. Cheng XBJ, Bargman J. Complications of Peritoneal Dialysis Part II: Nonmechanical Complications. Clin J Am Soc Nephrol. 2024 Jun 1; 19 (6): 791–799. doi: 10.2215/CJN.0000000000000418. PMID: 38190143.
29. Aggarwal HK, Jain D, Lathar M, Yadav RK, Sawhney A. Lipoprotein-A and carotid intima media thickness as cardiovascular risk factors in patients of chronic kidney disease. Ren Fail. 2010 Jul; 32 (6): 647–652. doi: 10.3109/0886022X.2010.486097. PMID: 20540630.
30. Chmielnicka K, Heleniak Z, Dębska-Ślizień A. Dyslipidemia in Renal Transplant Recipients. Transplantology. 2022 May 23; 3 (2): 188–199. doi: 10.3390/transplantology3020020.
31. Rahimi L, Rajpal A, Ismail-Beigi F. Glucocorticoid-Induced Fatty Liver Disease. Diabetes Metab Syndr Obes. 2020 Apr 16; 13: 1133–1145. doi: 10.2147/DMSO.S247379. PMID: 32368109.
32. Rostaing L, Jouve T, Terrec F, Malvezzi P, Noble J. Adverse Drug Events after Kidney Transplantation. J Pers Med. 2023 Dec 14; 13 (12): 1706. doi: 10.3390/jpm13121706. PMID: 38138933.
33. Iannuzzo G, Cuomo G, Di Lorenzo A, Tripaldella M, Mallardo V, Iaccarino Idelson P et al. Dyslipidemia in Transplant Patients: Which Therapy? J Clin Med. 2022 Jul 14; 11 (14): 4080. doi: 10.3390/jcm11144080. PMID: 35887846.
34. Al-Kuraishy HM, Sulaiman GM, Mohsin MH, Mohammed HA, Dawood RA, Albuhadily AK et al. Targeting of AMPK/MTOR signaling in the management of atherosclerosis: Outmost leveraging. Int J Biol Macromol. 2025 May; 309 (Pt 2): 142933. doi: 10.1016/j.ijbiomac.2025.142933. PMID: 40203916.
35. Arvanitis M, Lowenstein CJ. Dyslipidemia. Ann Intern Med. 2023 Jun; 176 (6): ITC81–ITC96. doi: 10.7326/AITC202306200. PMID: 37307585.
36. Wanner C, Tonelli M. Kidney Disease: Improving Global Outcomes Lipid Guideline Development Work Group Members. KDIGO Clinical Practice Guideline for Lipid Management in CKD: summary of recommendation statements and clinical approach to the patient. Kidney Int. 2014 Jun; 85 (6): 1303–1309. doi: 10.1038/ki.2014.31. PMID: 24552851.
37. Ponticelli C, Arnaboldi L, Moroni G, Corsini A. Treatment of dyslipidemia in kidney transplantation. Expert Opin Drug Saf. 2020 Mar; 19 (3): 257–267. doi: 10.1080/14740338.2020.1732921. PMID: 32073914.
38. Kim BK, Hong SJ, Lee YJ, Hong SJ, Yun KH, Hong BK et al. RACING investigators. Long-term efficacy and safety of moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (RACING): a randomised, open-label, non-inferiority trial. Lancet. 2022 Jul 30; 400 (10349): 380–390. doi: 10.1016/S0140-6736(22)00916-3. PMID: 35863366.
39. Michaeli DT, Michaeli JC, Albers S, Boch T, Michaeli T. Established and Emerging Lipid-Lowering Drugs for Primary and Secondary Cardiovascular Prevention. Am J Cardiovasc Drugs. 2023 Sep; 23 (5): 477–495. doi: 10.1007/s40256-023-00594-5. PMID: 37486464.
40. Luo B, Zhong S, Wang X, Guo P, Hou Y, Di W. Management of blood lipids in post-kidney transplant patients: a systematic review and network meta-analysis. Front Pharmacol. 2024 Oct 8; 15: 1440875. doi: 10.3389/fphar.2024.1440875. PMID: 39439889.
41. Canfora I, Pierno S. Hypertriglyceridemia Therapy: Past, Present and Future Perspectives. Int J Mol Sci. 2024 Sep 8; 25 (17): 9727. doi: 10.3390/ijms25179727. PMID: 39273674.
42. Pontremoli R, Bellizzi V, Bianchi S, Bigazzi R, Cernaro V, Del Vecchio L et al. Management of dyslipidaemia in patients with chronic kidney disease: a position paper endorsed by the Italian Society of Nephrology. J Nephrol. 2020 Jun; 33 (3): 417–430. doi: 10.1007/s40620020-00707-2. PMID: 32065354.
43. Tramontano D, Bini S, Maiorca C, Di Costanzo A, Carosi M, Castellese J et al. Renal Safety Assessment of Lipid-Lowering Drugs: Between Old Certainties and New Questions. Drugs. 2025 Jun; 85 (6): 755–775. doi: 10.1007/s40265-025-02158-0. PMID: 40106181.
44. Ray KK, Bays HE, Catapano AL, Lalwani ND, Bloedon LT, Sterling LR et al. CLEAR Harmony Trial. Safety and Efficacy of Bempedoic Acid to Reduce LDL Cholesterol. N Engl J Med. 2019 Mar 14; 380 (11): 1022–1032. doi: 10.1056/NEJMoa1803917. PMID: 30865796.
45. Nissen SE, Lincoff AM, Brennan D, Ray KK, Mason D, Kastelein JJP et al. CLEAR Outcomes Investigators. Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients. N Engl J Med. 2023 Apr 13; 388 (15): 1353–1364. doi: 10.1056/NEJMoa2215024. PMID: 36876740.
46. Barale C, Melchionda E, Morotti A, Russo I. PCSK9 Biology and Its Role in Atherothrombosis. Int J Mol Sci. 2021 May 30; 22 (11): 5880. doi: 10.3390/ijms22115880. PMID: 34070931.
47. Grzesk G, Dorota B, Wołowiec Ł, Wołowiec A, Osiak J, Kozakiewicz M, Banach J. Safety of PCSK9 inhibitors. Biomed Pharmacother. 2022 Dec; 156: 113957. doi: 10.1016/j.biopha.2022.113957. PMID: 36411665.
48. Xu S, Ilyas I, Little PJ, Li H, Kamato D, Zheng X et al. Endothelial Dysfunction in Atherosclerotic Cardiovascular Diseases and Beyond: From Mechanism to Pharmacotherapies. Pharmacol Rev. 2021 Jul; 73 (3): 924–967. doi: 10.1124/pharmrev.120.000096. PMID: 34088867.
49. Mayer G, Dobrev D, Kaski JC, Semb AG, Huber K, Zirlik A et al. Management of dyslipidaemia in patients with comorbidities: facing the challenge. Eur Heart J Cardiovasc Pharmacother. 2024 Nov 6; 10 (7): 608–613. doi: 10.1093/ehjcvp/pvae058. PMID: 39153964.
50. Ikegami Y, Inoue I, Inoue K, Shinoda Y, Iida S, Goto S et al. The annual rate of coronary artery calcification with combination therapy with a PCSK9 inhibitor and a statin is lower than that with statin monotherapy. NPJ Aging Mech Dis. 2018 Jun 22; 4: 7. doi: 10.1038/s41514-0180026-2. Erratum in: NPJ Aging. 2025 Mar 19; 11 (1): 19. doi: 10.1038/s41514-025-00208-1. PMID: 29951223.
51. Toth PP, Dwyer JP, Cannon CP, Colhoun HM, Rader DJ, Upadhyay A et al. Efficacy and safety of lipid lowering by alirocumab in chronic kidney disease. Kidney Int. 2018 Jun; 93 (6): 1397–1408. doi: 10.1016/j.kint.2017.12.011. Epub 2018 Mar 8. PMID: 29526502.
52. Alotaibi T, Nagib AM, Denewar A, Aboateya H, Halim MA, Mahmoud T et al. Inhibition of Proprotein Convertase Subtilisin/Kexin-9 After Kidney Transplant: Single-Center Experience Among Patients With High Cardiovascular Risk. Exp Clin Transplant. 2024 Jan; 22 (Suppl 1): 315–322. doi: 10.6002/ect.MESOT2023. P111. PMID: 38385418.
53. Voevoda MI, Gurevich VS, Ezhov MV, Sergienko IV. Inclisiran – a new era in lipid-lowering therapy. Kardiologiia. 2022 Jun 30; 62 (6): 57–62. [In Russ, English abstract]. doi: 10.18087/cardio.2022.6.n2115.
54. Wright RS, Collins MG, Stoekenbroek RM, Robson R, Wijngaard PLJ, Landmesser U et al. Effects of Renal Impairment on the Pharmacokinetics, Efficacy, and Safety of Inclisiran: An Analysis of the ORION-7 and ORION-1 Studies. Mayo Clin Proc. 2020 Jan; 95 (1): 77–89. doi: 10.1016/j.mayocp.2019.08.021. PMID: 31630870.
55. Ueberdiek L, Jehn U, Pavenstädt H, Gebauer K, Reuter S. Novel Therapeutic Strategies for Dyslipidemia: First Report of Inclisiran Therapy in a Kidney Transplanted Patient. Transpl Int. 2023 Jan 26; 36: 11104. doi: 10.3389/ti.2023.11104. Erratum in: Transpl Int. 2023 Mar 23; 36: 11313. doi: 10.3389/ti.2023.11313. PMID: 36776901.
Supplementary files
Review
For citations:
Samburov A.V., Khaibulina N.A., Kulik T.L., Galeev Sh.R. Dyslipidemia and lipid-lowering therapy in patients on renal replacement therapy: a literature review. Russian Journal of Transplantology and Artificial Organs. 2025;27(4):158-172. (In Russ.) https://doi.org/10.15825/1995-1191-2025-4-158-172
Views:
16
Email this article 