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Etiology and management of dyslipidemia in children with chronic kidney disease and end-stage renal disease.
Pediatr Nephrol. 2015 Dec; 30(12):2073-84.PN

Abstract

Lipids are essential components of cell membranes, contributing to cell fuel, myelin formation, subcellular organelle function, and steroid hormone synthesis. Children with chronic kidney disease (CKD) and end-stage renal disease (ESRD) exhibit various co-morbidities, including dyslipidemia. The prevalence of dyslipidemias in children with CKD and ESRD is high, being present in 39-65% of patients. Elevated lipid levels in children without renal disease are a risk factor for cardiovascular disease (CVD), while the risk for CVD in pediatric CKD/ESRD is unclear. The pathogenesis of dyslipidemia in CKD features various factors, including increased levels of triglycerides, triglyceride-rich lipoproteins, apolipoprotein C3 (ApoC-III), decreased levels of cholesterylester transfer protein and high-density lipoproteins, and aberrations in serum very low-density and intermediate-density lipoproteins. If initial risk assessment indicates that a child with advanced CKD has 2 or more co-morbidities for CVD, first-line treatment should consist of non-pharmacologic management such as therapeutic lifestyle changes and dietary counseling. Pharmacologic treatment of dyslipidemia may reduce the incidence of CVD in children with CKD/ESRD, but randomized trials are lacking. Statins are the only class of lipid-lowering drugs currently approved by the U.S. Food and Drug Administration (FDA) for use in the pediatric population. FDA-approved pediatric labeling for these drugs is based on results from placebo-controlled trial results, showing 30-50% reductions in baseline low-density lipoprotein cholesterol. Although statins are generally well tolerated in adults, a spectrum of adverse events has been reported with their use in both the clinical trial and post-marketing settings.

Authors+Show Affiliations

Center for Drug Evaluation and Research Office of New Drugs Division of Nonprescription Regulation Development, United States Food and Drug Administration, Silver Spring, MD, USA.Center for Devices and Radiological Health, Division of Reproductive, Gastro-Renal and Urological Devices, Renal Devices Branch, United States Food and Drug Administration, 10903 New Hampshire Avenue Building 66-G252, Silver Spring, MD, 20993, USA. dsilverstein2001@yahoo.com.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25801207

Citation

Khurana, Mona, and Douglas M. Silverstein. "Etiology and Management of Dyslipidemia in Children With Chronic Kidney Disease and End-stage Renal Disease." Pediatric Nephrology (Berlin, Germany), vol. 30, no. 12, 2015, pp. 2073-84.
Khurana M, Silverstein DM. Etiology and management of dyslipidemia in children with chronic kidney disease and end-stage renal disease. Pediatr Nephrol. 2015;30(12):2073-84.
Khurana, M., & Silverstein, D. M. (2015). Etiology and management of dyslipidemia in children with chronic kidney disease and end-stage renal disease. Pediatric Nephrology (Berlin, Germany), 30(12), 2073-84. https://doi.org/10.1007/s00467-015-3075-9
Khurana M, Silverstein DM. Etiology and Management of Dyslipidemia in Children With Chronic Kidney Disease and End-stage Renal Disease. Pediatr Nephrol. 2015;30(12):2073-84. PubMed PMID: 25801207.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Etiology and management of dyslipidemia in children with chronic kidney disease and end-stage renal disease. AU - Khurana,Mona, AU - Silverstein,Douglas M, Y1 - 2015/03/24/ PY - 2014/09/04/received PY - 2015/02/16/accepted PY - 2015/02/11/revised PY - 2015/3/25/entrez PY - 2015/3/25/pubmed PY - 2016/8/12/medline KW - Adverse events KW - Cardiovascular disease KW - Chronic kidney disease KW - Dietary counseling KW - Dyslipidemia KW - Lifestyle change KW - Statin therapy SP - 2073 EP - 84 JF - Pediatric nephrology (Berlin, Germany) JO - Pediatr Nephrol VL - 30 IS - 12 N2 - Lipids are essential components of cell membranes, contributing to cell fuel, myelin formation, subcellular organelle function, and steroid hormone synthesis. Children with chronic kidney disease (CKD) and end-stage renal disease (ESRD) exhibit various co-morbidities, including dyslipidemia. The prevalence of dyslipidemias in children with CKD and ESRD is high, being present in 39-65% of patients. Elevated lipid levels in children without renal disease are a risk factor for cardiovascular disease (CVD), while the risk for CVD in pediatric CKD/ESRD is unclear. The pathogenesis of dyslipidemia in CKD features various factors, including increased levels of triglycerides, triglyceride-rich lipoproteins, apolipoprotein C3 (ApoC-III), decreased levels of cholesterylester transfer protein and high-density lipoproteins, and aberrations in serum very low-density and intermediate-density lipoproteins. If initial risk assessment indicates that a child with advanced CKD has 2 or more co-morbidities for CVD, first-line treatment should consist of non-pharmacologic management such as therapeutic lifestyle changes and dietary counseling. Pharmacologic treatment of dyslipidemia may reduce the incidence of CVD in children with CKD/ESRD, but randomized trials are lacking. Statins are the only class of lipid-lowering drugs currently approved by the U.S. Food and Drug Administration (FDA) for use in the pediatric population. FDA-approved pediatric labeling for these drugs is based on results from placebo-controlled trial results, showing 30-50% reductions in baseline low-density lipoprotein cholesterol. Although statins are generally well tolerated in adults, a spectrum of adverse events has been reported with their use in both the clinical trial and post-marketing settings. SN - 1432-198X UR - https://www.unboundmedicine.com/medline/citation/25801207/Etiology_and_management_of_dyslipidemia_in_children_with_chronic_kidney_disease_and_end_stage_renal_disease_ L2 - https://dx.doi.org/10.1007/s00467-015-3075-9 DB - PRIME DP - Unbound Medicine ER -