The prevalence of lipid abnormalities is very high in patients with impaired renal function and after transplantation. Coronary heart disease (CHD) morbidity and mortality are impressive in these patients. No prevention study using lipid lowering agents is available in this population. Thus recommendations are still based on pathophysiological data or extrapolated from the results reported in prevention studies from kidney disease-free subjects. The treatment of hyperlipidemia can be recommended considering the expected reduction of events due to CHD. The lipid targets may be those recommended in other high risk patients: LDL-cholesterol < 120 mg/dl and triglycerides < 150 mg/dl. Unfortunately, the use of both statins and fibrates noteworthy is under restraint in case of renal failure and immunosuppressive therapy. Prospective clinical trials are needed to demonstrate the effect of lipid lowering on the course of chronic renal failure and graft dysfunction.
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