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Nephrological guidelines ignore Lp(a) despite its cardiovascular risk in chronic kidney disease, a review calling for better recognition (Clin Res Cardiol Suppl 2017)
Original title: Lipoprotein(a) in nephrological patients
This review by Hohenstein contrasts EAS/ESC lipid guidelines with the more conservative, restrictive recommendations from nephrological societies, which do not mention Lp(a) at all despite its established role as a cardiovascular risk factor. Retrospective and prospective studies suggest Lp(a) has relevant predictive value in chronic kidney disease (CKD), particularly stage 3, potentially carrying the same adverse effects as in the general population, yet no diagnostic or therapeutic guidance exists for CKD patients. The author argues this persistent lack of recognition breeds therapeutic nihilism, leaving relatively young CKD patients at significantly increased cardiovascular risk, and calls for further evaluation of Lp(a) in CKD to guide appropriate treatment of patients with elevated levels.
Original abstract
In contrast to existing EAS/ESC guidelines on the management of lipid disorders, current recommendations from nephrological societies are very conservative and restrictive with respect to any escalation of lipid lowering/statin therapy. Furthermore, lipoprotein(a) (Lp(a)) - an established cardiovascular risk factor - has not even been mentioned. While a number of retrospective and prospective studies suggested that Lp(a) has relevant predictive value and might have - at least in stage-3 chronic kidney disease (CKD) - the same negative effects if draged along in non-CKD patients, there is no guidance on diagnostic or therapeutic procedures. The persistent lack of recognition automatically leads to therapeutic nihilism, which might pose a number of relatively young patients to a significantly increased risk for adverse cardiovascular events. Further evaluation of Lp(a) in CKD is very important to provide appropriate treatment to patients with high Lp(a) levels, even in the presence of CKD.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.