From the Guidelines
Non-statin cholesterol medications that are safe for chronic kidney disease (CKD) patients include ezetimibe, PCSK9 inhibitors, and bile acid sequestrants, which can be used as alternatives to statins. These medications work through different mechanisms than statins, making them suitable options when statins aren't tolerated. The most recent and highest quality study, 1, recommends the use of non-statin medications, such as ezetimibe, bile acid sequestrants, and PCSK9 inhibitors, in combination with statin therapy to lower LDL-C levels. Some key points to consider when using these medications in CKD patients include:
- Ezetimibe is well-tolerated in CKD and doesn't require dose adjustment for kidney function, as stated in 1.
- PCSK9 inhibitors, such as evolocumab and alirocumab, are safe for CKD patients and highly effective at lowering LDL cholesterol, as shown in 1.
- Bile acid sequestrants, such as cholestyramine or colesevelam, can be used in CKD but may cause gastrointestinal side effects, as mentioned in 1.
- Fibrates, like fenofibrate, should be used cautiously in CKD with dose adjustments, while niacin is generally avoided due to side effects, as recommended in 1 and 1. It's essential to consult with a nephrologist and cardiologist before starting any new cholesterol medication to determine the most appropriate option based on specific kidney function, cholesterol levels, and overall health status.
From the FDA Drug Label
The LDL-C reduction achieved with the combination of colesevelam hydrochloride and any given dose of statin therapy was statistically superior to that achieved with colesevelam hydrochloride or that dose of the statin alone Colesevelam hydrochloride for oral suspension is a white to yellow granular powder containing yellow granules. Instruct patients to inform their physician about all the drugs and vitamins that they are prescribed or take over the counter
Colesevelam hydrochloride is a cholesterol medication that is not a statin.
- It can be used in combination with statins to reduce LDL-C levels.
- The medication has been studied in patients with heterozygous familial hypercholesterolemia (HeFH).
- However, there is no direct information in the provided drug label about the use of colesevelam hydrochloride in patients with chronic kidney disease (CKD).
- Patients with CKD should consult their physician before taking colesevelam hydrochloride, as the medication may have drug interactions and affect fat-soluble vitamin absorption 2.
From the Research
Cholesterol Medications
Cholesterol medications that are not statins and are friendly for patients with Chronic Kidney Disease (CKD) include:
- Ezetimibe: a cholesterol absorption inhibitor that has been shown to be safe and effective in reducing LDL-C levels in patients with CKD 3
- PCSK9 inhibitors: monoclonal antibodies that target proprotein convertase subtilisin/kexin 9 (PCSK9) and have been shown to reduce LDL-C and lipoprotein(a) in high-risk populations, including those with CKD 4
- Fibrates: such as fenofibrate, which can lower triglyceride levels, but may require dose adjustments based on renal function 5
- Omega-3 fatty acids: which can lower triglyceride levels, but their cardiorenal benefits in patients with CKD are not yet established 5
Key Considerations
When considering cholesterol medications for patients with CKD, it is essential to:
- Assess the patient's renal function and adjust medication doses accordingly 5
- Monitor for potential adverse events, such as changes in kidney function or increased risk of cardiovascular events 6
- Consider the patient's overall cardiovascular risk profile and tailor treatment strategies accordingly 7
Treatment Strategies
Treatment strategies for hyperlipidemia in patients with CKD may include: