Values and preferences: If the preference is to partake in early prevention and long-term risk reduction, in subjects younger than 50 years the absolute risk of events is lower but studies suggest that statins will result in a relative risk reduction similar to those older than 50 years. The statin/ezetimibe combination recommendation is on the basis of the SHARP study, which used 20 mg of simvastatin and 10 mg of ezetimibe.
Recommendation: We suggest that lipid-lowering therapy not be initiated in adults with dialysis-dependent CKD (Conditional Recommendation; Moderate-Quality Evidence).
Values and preferences: In younger individuals who might become eligible for kidney transplantation or with a longer life expectancy, statin or statin/ezetimibe combination therapy might be desirable although high-quality studies have not been done in this population.
Recommendation: We suggest that lipid-lowering therapy be continued in adults already receiving it at the time of dialysis initiation (Conditional Recommendation; Low-Quality Evidence).
Values and preferences: This recommendation reflects that fact that a substantial number of patients in SHARP transitioned to dialysis during the study and there was no heterogeneity of results for the population as a whole. The evidence is of low quality overall and there is substantial debate about best practice in this situation.
Recommendation: We suggest the use of statin therapy in adults with kidney transplantation (Conditional Recommendation; Moderate-Quality Evidence).