Health & Medical Kidney & Urinary System

KDIGO Clinical Practice Guideline for Lipid Management in CKD

´╗┐KDIGO Clinical Practice Guideline for Lipid Management in CKD

The Atherosclerotic Process Begins in Childhood

Many studies document the prevalence of dyslipidemia among children with CKD and end stage renal disease. As in adults, the pattern of dyslipidemias in children with CKD is greatly influenced by the underlying pathogenesis and duration of CKD, severity of proteinuria, and treatment.

In children or adolescents with CKD, the relationship between dyslipidemias and subsequent atherosclerotic clinical events is not known owing to short follow-up in observational studies or clinical trials. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study shows, in adolescents with normal kidney function, that atherosclerosis begins in childhood. This atherosclerotic process is likely accelerated in nephrotic syndrome, proteinuric states, and chronic kidney disease (CKD) owing to abnormal lipid metabolism and other atherogenic risk factors.

The frequency of lipid abnormalities suggests that clinicians should measure lipid levels at baseline in children with CKD to screen for underlying secondary causes of dyslipidemia.

Children with CKD (and their families) place a high value on this potential benefit and are less concerned about the possibility of adverse events or inconvenience associated with baseline measurement of lipid levels. In the judgment of the Work Group, these considerations justify a strong recommendation despite the low quality of the available evidence.

Children with very severely increased hypertriglyceridemia (>11.3 mmol/l (>1000 mg/dl)) should be referred to a pediatric lipid specialist for management and to rule out familial hypertriglyceridemia or rare, inherited disorders such as lipoprotein lipase deficiency or apolipoprotein C-II deficiency.

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