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Management of Hyperlipidemia in Patients With Liver Impairment or Renal Impairment

Zachary T. Bloomgarden, MD, MACE, discusses the appropriateness of statin therapy in patients who have comorbidities such as liver or kidney disease.

Zachary T. Bloomgarden, MD, MACE: In individuals with liver disease, one has to be cognizant that there is a small but definite potential for abnormalities of liver chemistries with statins. By and large, individuals with chronic liver disease do tolerate statins well, although they (patients) require careful observation of liver chemistries.
In the setting of acute hepatitis, the better part of valor would be to avoid statin therapy since the statins really should be seen as long-term drugs, not drugs that must be given every moment of an individual’s lifetime.
Liver disease should be a consideration, but the minor abnormalities of liver chemistry, which occur with statin therapy, are currently seen as not representing serious clinical conditions.
With renal disease, there is a bit of evidence that very high doses of statins, particularly rosuvastatin, may have adverse effects on renal function. So, as a consequence, one needs to use these drugs with a bit of greater caution in individuals with renal insufficiency. There’s also some evidence that individuals with very advanced kidney disease at the level of dialysis or just predialysis may have attenuation of the benefit of statins in reducing cardiovascular end points. So this is a group to bear in mind, and certainly we do have to be careful in individuals with any severe chronic kidney disease (CKD) when administering statins.
But they [statins] are effective agents and we have to remember that individuals with CKD, especially those with stage 3 and higher CKD, rarely die of progression to end-stage renal disease. Rather, in those individuals, CKD is essentially a cardiovascular risk marker. As such, the prevention of cardiovascular disease, which we know statins can offer, is of much greater importance than the potential interaction. So monitor, monitor, monitor. Be careful in administering these drugs, but individuals with CKD can [absolutely] receive statins when used appropriately.
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