Lipid and other management to improve arterial disease and survival in end stage renal disease

Simon B. Dimmitt, Jennifer H. Martin

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Introduction: Arterial disease is common in advancing renal failure, culminating in myocardial infarction with cardiac failure, strokes and peripheral and renal artery disease. Attention to cardiac and arterial disease may slow deterioration of renal function. Management of risk factors can reduce these sequelae. Areas covered: Modifiable risk factors for arterial disease and relevant pharmacotherapies. Expert opinion: Cardiovascular disease is the biggest killer in renal failure. Statins are viewed as essential in symptomatic coronary disease and have been shown in non-renal patients to improve survival after myocardial infarction. Cochrane recommends statins in renal failure but not in end stage renal disease or transplant patients. Large well powered clinical trials focussed specifically on renal patients failed to demonstrate cardiovascular outcome or mortality benefits of statins when compared to placebo. Other lipid lowering pharmacotherapies are weaker and adverse effects may account for the absence of net clinical benefit in non-renal patients in published clinical trials. Patients should be started on a statin after myocardial infarction, regardless of lipid levels, but the risk of adverse effects in advanced renal failure with its comorbidities predicates employing only essential doses. Optimal antihypertensive and antithrombotic pharmacotherapy are also priorities.

Original languageEnglish
Pages (from-to)343-349
Number of pages7
JournalExpert Opinion on Pharmacotherapy
Volume18
Issue number4
DOIs
Publication statusPublished - 4 Mar 2017

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