***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Although patients with chronic kidney disease ( CKD ) are at increased risk of cardiovascular disease ( CVD ) , the roles of lipid-modifying therapies in decreasing CVD risk are unclear . Our aim is to compare the effects of statin and fibrate therapy on arterial function as a risk marker of CVD . STUDY DESIGN Double-blind , r and omized , placebo-controlled , parallel-group study . SETTING & PARTICIPANTS Ambulatory patients with stages 3 to 5 CKD . INTERVENTION 6 weeks of atorvastatin , 40 mg/d , or gemfibrozil , 600 mg twice daily , with placebo . OUTCOMES & MEASUREMENTS Primary outcome was arterial function assessed by means of endothelial-dependent flow-mediated dilatation ( FMD ) and small-artery compliance ( C2 ) . Secondary outcomes included endothelial-independent glyceryl trinitrate-mediated dilatation ( GTNMD ) , large-artery compliance ( C1 ) , and levels of lipids , lipoproteins , and oxidized low-density lipoprotein , as well as markers of insulin resistance and inflammation . RESULTS Compared with placebo , atorvastatin significantly decreased low-density lipoprotein ( -52 % ) , triglyceride ( -30 % ) , and oxidized low-density lipoprotein levels ( -41 % ; P < 0.0001 ) . Gemfibrozil significantly decreased triglyceride levels ( -40 % ) and increased high-density lipoprotein levels ( + 20 % ; P < 0.0001 ) . Neither atorvastatin nor gemfibrozil had a significant effect on markers of insulin resistance or inflammation . There was no significant change in FMD , GTNMD , or C1 with either atorvastatin or gemfibrozil . There was improvement in C2 with atorvastatin ( + 1.1 mL/mm Hg x 100 ) compared with placebo ( P = 0.024 ) , but not with gemfibrozil compared with placebo . LIMITATIONS Small sample size leading to inadequate power , short duration of therapy , and use of a heterogeneous group of patients with CKD and dialysis patients . CONCLUSION In patients with advanced CKD , atorvastatin is associated with improvement in dyslipidemia and small-artery stiffness , but not endothelial function .  Gemfibrozil improves dyslipidemia , but has no effect on arterial function Background Patients with end-stage renal disease ( ESRD ) are at high risk of cardiovascular events . Multiple risk factors for atherosclerosis are present in ESRD and may contribute to the increased risk of cardiovascular mortality in this population . In contrast to patients with normal renal function , the benefits of modifying lipid levels on cardiovascular outcomes in patients with ESRD on haemodialysis have yet to be confirmed in large prospect i ve r and omised trials . A study to evaluate the Use of Rosuvastatin in subjects On Regular haemodialysis : an Assessment of survival and cardiovascular events ( AURORA ) will be the first large-scale international trial to assess the effects of statin therapy on cardiovascular morbidity and mortality in ESRD patients on chronic haemodialysis . Methods More than 2,750 ESRD patients who have been receiving chronic haemodialysis treatment for at least 3 months have been r and omised ( 1:1 ) , irrespective of baseline lipid levels , to treatment with  rosuvastatin 10 mg or placebo . The primary study endpoint is the time to a major cardiovascular event ( first occurrence of cardiovascular death , non-fatal myocardial infa rct ion or non-fatal stroke ) . Secondary endpoints include all-cause mortality , major cardiovascular event-free survival time , time to cardiovascular death , time to non-cardiovascular death , cardiovascular interventions , tolerability of treatment and health economic costs per life-year saved . Study medication will be given until 620 subjects have experienced a major cardiovascular event . Conclusion Our hypothesis is that results from AURORA will establish the clinical efficacy and tolerability of rosuvastatin in patients with ESRD receiving chronic haemodialysis and guide the optimal management of this exp and ing population Statins have multiple effects , including anti-inflammatory actions , lowering C-reactive protein levels , and reducing coronary events . We performed a post hoc analysis of the r and omized placebo-controlled 4D Study that had evaluated the efficacy and safety of atorvastatin in 1255 patients with type 2 diabetes mellitus who were on maintenance hemodialysis . Here we determined the relationship between atorvastatin treatment , C-reactive protein , and the outcome of patients who had pre-specified and adjudicated endpoints of all-cause mortality , composite vascular endpoint , myocardial infa rct ion , sudden death , and stroke .  Atorvastatin had no significant effect on the risk of composite vascular endpoint or death relative to placebo in any quartile of baseline C-reactive protein . These baseline levels were not significantly different between the treated and placebo group and remained stable at 6 months on atorvastatin but significantly increased in those patients on placebo . All of the patients with baseline C-reactive protein in the fourth quartile had a significantly increased risk of deaths and in composite vascular endpoint compared to patients in the first quartile . The mean value of two consecutive C-reactive protein measurements was associated with significant increases in the risk of sudden death , stroke , all-cause mortality and composite vascular endpoint . Our results show that C-reactive protein was highly predictive of outcome , but atorvastatin treatment was not associated with reduced relative risks in the composite vascular endpoint or mortality in patients on hemodialysis with or without inflammation Background The high incidence of cardiovascular disease in patients with end stage renal disease ( ESRD ) is related to the accumulation of uremic toxins in the middle and large-middle molecular weight range . As online hemodiafiltration ( HDF ) removes these molecules more effectively than st and ard hemodialysis ( HD ) , it has been suggested that online HDF improves survival and cardiovascular outcome . Thus far , no conclusive data of HDF on target organ damage and cardiovascular morbidity and mortality are available . Therefore , the CONvective TRAnsport STudy ( CONTRAST ) has been initiated . Methods CONTRAST is a Dutch multi-center r and omised controlled trial . In this trial , approximately 800 chronic hemodialysis patients will be r and omised between online HDF and low-flux HD  , and followed for three years . The primary endpoint is all cause mortality . The main secondary outcome variables are fatal and non-fatal cardiovascular events . Conclusion The study is design ed to provide conclusive evidence whether online HDF leads to a lower mortality and less cardiovascular events as compared to st and ard HD The efficacy , tolerability and safety of simvastatin in the treatment of hyperlipemia in uremic patients undergoing hemodialysis were evaluated in 6 patients ; a further 6 patients were treated with placebo and represented the control group . All patients treated completed the study . No clinical or laboratory side-effects were noted during the entire period of observation . Simvastatin caused a significant 26 % reduction in total cholesterol , a 36 % reduction in LDL cholesterol and a 28 % reduction in triglycerides ; HDL cholesterol and Apolipoprotein A increased by 19 % and 12 % respectively Summary Background Lowering LDL cholesterol with statin regimens reduces the risk of myocardial infa rct ion , ischaemic stroke , and the need for coronary revascularisation in people without kidney disease , but its effects in people with moderate-to-severe kidney disease are uncertain . The SHARP trial aim ed to assess the efficacy and safety of the combination of simvastatin plus ezetimibe in such patients . Methods This r and omised double-blind trial included 9270 patients with chronic kidney disease ( 3023 on dialysis and 6247 not ) with no known history of myocardial infa rct ion or coronary revascularisation . Patients were r and omly assigned to simvastatin 20 mg plus ezetimibe 10 mg daily versus matching placebo . The key prespecified outcome was first major atherosclerotic event ( non-fatal myocardial infa rct ion or coronary death , non-haemorrhagic stroke , or any arterial revascularisation procedure ) . All analyses were by intention to treat . This trial is registered at Clinical Trials.gov , NCT00125593 , and IS RCT N54137607 . Findings 4650 patients were assigned to  receive simvastatin plus ezetimibe and 4620  to placebo . Allocation to simvastatin plus ezetimibe yielded an average LDL cholesterol difference of 0·85 mmol/L ( SE 0·02 ; with about two-thirds compliance ) during a median follow-up of 4·9 years and produced a 17 % proportional reduction in major atherosclerotic events ( 526 [ 11·3 % ] simvastatin plus ezetimibe vs 619 [ 13·4 % ] placebo ; rate ratio [ RR ] 0·83 , 95 % CI 0·74–0·94 ; log-rank p=0·0021 ) . Non-significantly fewer patients allocated to simvastatin plus ezetimibe had a non-fatal myocardial infa rct ion or died from coronary heart disease ( 213 [ 4·6 % ] vs 230 [ 5·0 % ] ; RR 0·92 , 95 % CI 0·76–1·11 ; p=0·37 ) and there were significant reductions in non-haemorrhagic stroke ( 131 [ 2·8 % ] vs 174 [ 3·8 % ] ; RR 0·75 , 95 % CI 0·60–0·94 ; p=0·01 ) and arterial revascularisation procedures ( 284 [ 6·1 % ] vs 352 [ 7·6 % ] ; RR 0·79 , 95 % CI 0·68–0·93 ; p=0·0036 ) . After weighting for subgroup-specific reductions in LDL cholesterol , there was no good evidence that the proportional effects on major atherosclerotic events differed from the summary rate ratio in any subgroup examined , and , in particular , they were similar in patients on dialysis and those who were not . The excess risk of myopathy was only two per 10 000 patients per year of treatment with this combination ( 9 [ 0·2 % ] vs 5 [ 0·1 % ] ) . There was no evidence of excess risks of hepatitis ( 21 [ 0·5 % ] vs 18 [ 0·4 % ] ) , gallstones ( 106 [ 2·3 % ] vs 106 [ 2·3 % ] ) , or cancer ( 438 [ 9·4 % ] vs 439 [ 9·5 % ] , p=0·89 ) and there was no significant excess of death from any non-vascular cause ( 668 [ 14·4 % ] vs 612 [ 13·2 % ] , p=0·13 ) . Interpretation Reduction of LDL cholesterol with simvastatin 20 mg plus ezetimibe 10 mg daily safely reduced the incidence of major atherosclerotic events in a wide range of patients with advanced chronic kidney disease . Funding Merck/Schering-Plough Pharmaceuticals ; Australian National Health and Medical Research Council ; British Heart Foundation ; UK Medical Research Council BACKGROUND Cardiovascular disease as a result of accelerated atherogenesis is common in patients with end-stage renal disease ( ESRD ) . Dyslipidemia may be a major contributor in this process and can be influenced by lipid-lowering drugs ( statins ) . Moreover , statins may exhibit additional inhibitory effects on the atherogenesis , such as a modulation of the immune system as triggered by oxidatively modified LDL and a reduction of the inflammatory marker C-reactive protein ( CRP ) . METHODS We evaluated in a single-blind r and omized trial of 28 ESRD patients on hemodialysis , the dose-depending effects of both atorvastatin and simvastatin on lipids , lipoproteins , LDL particle heterogeneity , high sensitive-CRP , and markers of in vivo LDL oxidation . RESULTS Both statin therapies significantly lowered total plasma cholesterol and LDL-cholesterol concentrations to the same extent , whereas reduction in the concentrations of triglyceride-rich particles was less pronounced . Furthermore , statin therapy reduced LDL cholesterol in all LDL subfractions , without altering the overall LDL particle density . After both statins plasma hs-CRP concentrations were not significantly reduced ; parameters of in vivo LDL oxidation ( plasma ox-LDL concentration and the oxidation level of isolated LDL ) , were significantly decreased . Autoantibodies against ox-LDL , however , did not change during this trial period . CONCLUSIONS These results show that atorvastatin and simvastatin exhibit comparable favourable effects on lipid profiles in ESRD . Moreover , the reduction of in vivo oxidatively modified LDL as shown in this ESRD population , may indicate that these statins exhibit favourable effects on oxidative stress in vivo Objective . There have been no endpoint studies with statins for patients with severe renal failure . The purpose of this prospect i ve , open , r and omized , controlled study 
    Output:
    
Statins have little or no beneficial effects on mortality or cardiovascular events and uncertain adverse effects in adults treated with dialysis despite clinical ly relevant reductions in serum cholesterol levels