Treatment of dyslipidemia in kidney transplantation: Expert Opinion on Drug Safety

C. Ponticelli, L. Arnaboldi, G. Moroni, A. Corsini

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Lipid disorders are frequent after kidney transplantation (KT) and KT recipients are considered at high- or very-high cardiovascular risk. Among many concurring factors, a major role is played by immunosuppressants. Areas covered: General measures to manage lipid disorders first include physical activity and diet counseling. Modulating the doses of immunosuppressants also improves dyslipidemia. When lipid-lowering drugs are necessary to control elevated plasma cholesterol and/or triglycerides, statins are the cornerstone for managing hypercholesterolemia. However, side-effects (e.g. myopathy, new-onset diabetes, and kidney graft dysfunction) may occur. In these cases, ezetimibe (which does not affect kidney function) alone or on top of statins for the severe cases, is suggested by the most recent Guidelines. Proprotein convertase subtilisin/kexin type9 inhibitors are promising but expensive and their use in KT is still limited. Expert opinion: In KT recipients, statins should be used cautiously. Rather than using high-dose statin in difficult patients, an association with ezetimibe is suggested. While fibrates, niacin, and resins do not play a relevant role due to their erratic efficacy and common side-effects, new lipid-lowering drugs are emerging but their safety and efficacy in KT patients still need to be assessed. © 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group.
Original languageEnglish
Pages (from-to)257-267
Number of pages11
JournalExpert Opin. Drug Saf.
Volume19
Issue number3
DOIs
Publication statusPublished - 2020

Keywords

  • cardiovascular disease
  • Dyslipidemia
  • kidney transplantation
  • statins
  • antilipemic agent
  • bempedoic acid
  • bile acid sequestrant
  • calcineurin inhibitor
  • ezetimibe
  • fibric acid derivative
  • fish oil
  • glucocorticoid
  • hydroxymethylglutaryl coenzyme A reductase inhibitor
  • inclisiran
  • mammalian target of rapamycin inhibitor
  • peroxisome proliferator activated receptor alpha agonist
  • immunosuppressive agent
  • cholesterol blood level
  • drug efficacy
  • drug safety
  • dyslipidemia
  • human
  • hypolipemia
  • immunosuppressive treatment
  • pathophysiology
  • physical activity
  • practice guideline
  • Review
  • treatment outcome
  • adverse event
  • disease management
  • drug interaction
  • Disease Management
  • Drug Interactions
  • Dyslipidemias
  • Ezetimibe
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Hypolipidemic Agents
  • Immunosuppressive Agents
  • Kidney Transplantation

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