In a patient with stage 4 chronic kidney disease, what is the recommended approach to manage hyperlipidemia upon starting hemodialysis?

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In patients with stage 4 chronic kidney disease (CKD) who are initiating hemodialysis, the management of hyperlipidemia often involves continuing current statin therapy. Research indicates that statins can still provide cardiovascular benefits in patients with end-stage renal disease, despite some concerns regarding the safety and efficacy of these medications in advanced stages of kidney impairment.

The existing guidelines recommend that statin therapy should be maintained in patients already receiving treatment, as discontinuation may lead to an increased risk of cardiovascular events. Dialysis does not significantly alter the pharmacokinetics of most statins, making it generally safe to continue the same dose for those who were on statins before starting hemodialysis.

In contrast, changing to a lower dosage of simvastatin or switching to ezetimibe only may not provide the desired lipid-lowering effect and could limit the potential cardiovascular protective effects associated with statin therapy. Discontinuing all hyperlipidemia medications is not advisable, as patients with advanced kidney disease still face significant cardiovascular risks.

Thus, maintaining the current statin therapy allows patients to continue benefiting from its cardioprotective properties while managing their lipid levels effectively.

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