What therapies might be considered to lower LDL-C in patients with advanced CKD?
Therapies that may be considered to lower LDL-C in patients with advanced CKD include cholesterol absorption inhibitors and non-systemic bile acid sequestrants. An RCT in adults 40 years of age with advanced CKD and without known CHD at baseline found that the addition of ezetimibe to a moderate-intensity statin lowered LDL-C 43 mg/dL (1.1 mmol/L). Bile acid sequestrants used as monotherapy reduced CHD endpoints in a large primary prevention population, but can bind other drugs, so other medications must be avoided for 1 hour before and at least 3 to 4 hours after administration. Adding psyllium can minimize constipation and can reduce the bile acid sequestrant dose.