Precision Medicine and Personalized Management of Lipoprotein and Lipid Disorders in Chronic and End-Stage Kidney Disease

Semin Nephrol. 2018 Jul;38(4):369-382. doi: 10.1016/j.semnephrol.2018.05.007.

Abstract

Precision medicine is an emerging field that calls for individualization of treatment strategies based on characteristics unique to each patient. In lipid management, current guidelines are driven mainly by clinical trial results that presently indicate that patients with non-dialysis-dependent chronic kidney disease (CKD) should be treated with a β-hydroxy β-methylglutaryl-CoA reductase inhibitor, also known as statin therapy. For patients with end-stage kidney disease (ESKD) being treated with hemodialysis, statin therapy has not been shown to successfully reduce poor outcomes in trials and therefore is not recommended. The two major guidelines dissent on whether statin therapy should be of moderate or high intensity in non-dialysis-dependent CKD patients, but often leave the prescribing clinician to make that decision. These decisions often are complicated by the increased concerns for adverse events such as myopathies in patients with advanced kidney disease and ESKD. In the future, there may be an opportunity to further identify CKD and ESKD patients who are more likely to benefit from lipid-modifying therapy as opposed to those who likely will suffer from its side effects using precision medicine tools. For now, data from genetics studies and subgroup analyses may provide insight for future research directions in this field and we review some of the work that has been published in this regard.

Keywords: CKD; Precision medicine; dialysis; lipid therapy; statin.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Anticholesteremic Agents / therapeutic use*
  • Cardiovascular Diseases / metabolism
  • Dyslipidemias / complications
  • Dyslipidemias / drug therapy*
  • Dyslipidemias / metabolism
  • Ezetimibe / therapeutic use
  • Fenofibrate / therapeutic use
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Hypolipidemic Agents / therapeutic use
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / metabolism
  • Kidney Failure, Chronic / therapy*
  • Muscular Diseases / chemically induced
  • Muscular Diseases / genetics
  • Niacin / therapeutic use
  • PCSK9 Inhibitors
  • Pharmacogenomic Variants
  • Practice Guidelines as Topic
  • Precision Medicine*
  • Renal Dialysis
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / metabolism

Substances

  • Anticholesteremic Agents
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Hypolipidemic Agents
  • PCSK9 Inhibitors
  • Niacin
  • Ezetimibe
  • Fenofibrate