Dyslipidemia in children and adolescents with CKD G1-G5, on dialysis and after transplantation: a narrative review of clinical studies and practical guidelines

Introduction. In recent years, childhood has been recognized as a "window of opportunity" to reduce both the prevalence of cardiovascular diseases (CVD) and their long-term impact on life expectancy and health in adulthood. Children and adolescents with chronic kidney disease (CKD) face a significantly increasing risk of developing CVD later in life. This narrative review aims to highlight the importance of studying dyslipidemia in children and adolescents with CKD and to provide a theoretical foundation for future reseach. The key research questions focus on assessing the prevalence of dyslipidemia, conducting a comparative analysis of clinical practice guidelines, and summarizing the findings of clinical trials evaluating the efficacy and safety of lipid-lowering therapies of this patient population.

Methods. A narrative review was conducted by searching for relevant articles on PubMed and on eLIBRARY.RU Scientific Electronic Library.

Results. The search identified 27 publications including: 11 observational studies; 9 clinical practice guidelines for lipid management in children and adolescents with CKD; and 7 clinical trials evaluating the efficacy and safety of lipid-lowering therapy. A key finding was the use of varying diagnostic criteria in observational studies. In studies that followed standardized diagnostic guidelines, the reported prevalence of dyslipidemia was: 61.5% – 71.8% in patients with CKD G1-G5 without renal replacement therapy; 85.1% in patients on peritoneal dialysis; 76.1% in patients on hemodialysis; 54.2% – 55.5% in post-kidney transplantation. Dyslipidemia was most commonly characterized by elevated triglycerides and reduced high-density lipoprotein (HDL) cholesterol level. Significant inconsistencies were noticed in clinical practical guidelines for lipid management in children and adolescents with CKD, with recommendations generally based on low or very low level of evidence. All clinical trials assessing the efficacy and safety of statins in pediatric CKD patients had notable limitations. However, most studies reported a reduction in major lipid fractions with statin therapy, and no clinically significant adverse effects were observed after short-term treatment courses.

Conclusions. The review confirmes the high prevalence of dyslipidemia in children and adolescents with CKD. Significant inconsistencies in existing clinical practice guidelines and a lack of strong evidence were identified. Currently, nonpharmacological therapy remains the primary focus of both scientific research and clinical practice. To optimize its effectiveness, there is a need to develop educational resources for healthcare professionals and patients.

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