Treatment of dyslipidemia in patients with metabolic syndrome and chronic kidney disease


Authors: V. Monhart 1,2
Authors‘ workplace: Interní klinika 1. lékařské fakulty UK a ÚVN Praha, přednosta prof. MUDr. Miroslav Zavoral, Ph. D. 1;  KlinLab s. r. o. Praha 2
Published in: Vnitř Lék 2009; 55(7-8): 671-678
Category: 134th Internal Medicine Day - 23rd Vanysek's Day Brno 2009 - Vanysek's Lecture

Overview

Dyslipidemia, often present in patients with metabolic syndrome and chronic kidney disease, contributes to increased cardiovascular risk and progression of renal impairment. In these patients, the probability of death from cardiovascular complications is higher than death consequent to terminal renal failure. Positive neuroprotective effects of statins and fibrates are being attributed to hypolipidemic as well as other, lipid-unrelated, properties. Statins are able to slow down the decline in glomerular filtration rate and may decrease proteinuria. Nevertheless, conclusive evidence that statins decrease the incidence of cardiovascular complications in patients with advanced chronic kidney disease is still lacking. Through their effect on albuminuria, fibrates contribute to slowing down of the progression of diabetic nephropathy. Controlled trials and clinical practice have shown that monotherapy with statins as well as fibrates is safe. Management of combined dyslipidemia requires, apart from the selection of a suitable statin-fibrate combination, careful monitoring of potential adverse effects and treatment tolerability and compliance. The results of the Czecho-Slovakian pivot study KOLCHRI have demonstrated the efficacy and safety of fenofibrate combined with low dose statin in patients with metabolic syndrome and stage 2–4 chronic kidney disease.

Key words:
dyslipidemia – metabolic syndrome – chronic kidney disease – statins – fibrates – KOLCHRI study


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Diabetology Endocrinology Internal medicine
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