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The risk of atherosclerotic cardiovascular disease (ASCVD) in patients with end-stage renal disease (ESRD, kidney failure) on dialysis is 10 to 20 times higher than in the general population. Despite their high risk for cardiovascular disease, two-thirds of kidney dialysis patients are not treated for hyperlipidemia (high levels of cholesterol or triglycerides) as national guidelines suggest. Dialysis patients have a high risk of ASCVD, but dialysis patients with higher serum cholesterol have lower mortality rates. While this paradoxical effect is thought to be largely due to other coexisting medical problems and poor nutritional status of dialysis patients, it may discourage clinicians from aggressively treating hyperlipidemia.
Clinicians might also be worried about drug safety issues in ESRD patients, explains Neil R. Powe, M.D., M.P.H., M.B.A., of Johns Hopkins University. In the study, which was supported in part by the Agency for Healthcare Research and Quality (HS08365), Dr. Powe and his colleagues assessed the prevalence, treatment, and control of hyperlipidemia in 812 hemodialysis (HD) and peritoneal dialysis (PD) patients at clinics in 19 States from 1995 to 1998.
Hyperlipidemia was present in 40 percent of HD and 62 percent of PD patients. Among those with hyperlipidemia, 67 percent of HD and 63 percent of PD patients were untreated, and only 22 percent of HD and 14 percent of PD patients were both treated and controlled. Individuals who entered the study in 1997 and 1998, those with diabetes, males, and whites were more likely to be treated and controlled, while those on PD and those with ASCVD were less likely to be treated and controlled.
See "Undertreatment of hyperlipidemia in a cohort of United States kidney dialysis patients," by Caroline S. Fox, M.D., M.P.H., J. Craig Longenecker, M.D., Ph.D., Dr. Powe, and others, in the May 2004 Clinical Nephrology 61(5), pp. 299-307.
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