Cholesterol AND Kidney Disease

CHOLESTEROL
AND
KIDNEY DISEASE
. What is cholesterol?
. Does the cholesterol level matter if I have kidney
disease?
. How can someone with kidney disease help keep
their blood vessels normal?
. What causes a high cholesterol level?
. What is the ideal cholesterol level?
. What is the best diet for reducing cholesterol?
. What drugs are used to reduce cholesterol?
. Who should have drugs to lower cholesterol levels?
What is cholesterol?
Cholesterol is a fatty substance, one of several different types of fat found

in the body. It has several very important functions, and is carried around
in the blood. If blood vessels are damaged, cholesterol can be deposited,
eventually causing narrowing to the blood vessels. This is more likely to
occur if the blood level of cholesterol is high.
Does the cholesterol level matter if I have kidney disease?
Yes, most definitely. Research has shown, people with kidney disease are
at increased risk of heart attack or stroke, especially if they are above the
age of 50years. They are also more likely to have problems with narrowing
of their blood vessels over time, compared to than otherwise healthy
people. This applies even with minor abnormalities in the kidneys, when
there is chronic kidney disease.
Problems with blood vessels in people with kidney disease may differ
slightly from those in people with normal kidneys, because abnormalities
with the minerals calcium and phosphate, and in vitamin D, may contribute
to blood vessel disease. However, cholesterol remains an important
factor.
How can someone with kidney disease help keep their blood vessels
normal?
There is much more to keeping blood vessels healthy than just looking at
the cholesterol level.
Attention needs to be paid to several areas:-

1. Stop smoking if you smoke. Smoking is more dangerous than
having a slightly high cholesterol, and can cause cancers as well as
accelerate disease of the blood vessels.
2. Lose weight, if you are overweight.
3. Take regular exercise and eat a healthy, balanced diet.
4. Make sure the blood pressure is controlled.
5. Control diabetes as well as possible, if you are diabetic.
6. Ask your doctor if you would benefit from taking a small dose of
aspirin each day to thin the blood slightly.
7. Ensure you are on the appropriate calcium and phosphate diet, as
advised by your kidney dietician.
What causes a high cholesterol level?
The cholesterol level depends on several factors. If someone has a high

cholesterol level, other family members may also have high cholesterol
levels. Kidney conditions that lead to protein leak in the urine are
associated with a high cholesterol, for example nephrotic syndrome and
after transplantation, partly due to the drugs used.
Diet and exercise also have a large effect on cholesterol levels. A diet
high in fat and cholesterol may lead to a high cholesterol level. Someone
who is very ill and malnourished may have an unusually low cholesterol
level.
What is the ideal cholesterol level?
Research shows that low cholesterol levels are beneficial, and the medical
advice about ideal cholesterol levels is changing in line with ongoing
research. The Renal Association in the UK, along with the Association
of Clinical Diabetologists have recommended (in 2021) that people with
kidney disease who are at risk of disease in their blood vessels should
have a total cholesterol level of less than 4.0 mmol/l.
Cholesterol is carried around the body in several different forms and as

well as measuring the total cholesterol level, laboratories also measure
other forms of cholesterol within the total level. One of these is HDL (high
density lipoprotein) cholesterol, which includes cholesterol coming out
of the tissues and being taken back to the liver for ‘recycling’. A higher
level of HDL cholesterol is therefore a good cholesterol.
LDL (low density lipoprotein) cholesterol is the fraction which is most

strongly associated with cholesterol being laid down in ‘bad’ cholesterol.
. The Renal Association guideline says that the level of LDL cholesterol
should be less than 2.0 mmol/l.
These ‘ideal’ levels of cholesterol are quite low and not achievable in
everyone; a reduction from the initial level of 25% for total cholesterol and
30% for LDL are recommended to be adequate by the Renal Association.
The target levels given above are different from those in some other
guidelines and will undoubtedly change in the future. So, if someone
does have cholesterol levels above these rather strict targets, they should
discuss with their doctors the benefits of having lower cholesterol levels
in their individual case.
What is the best diet for reducing cholesterol?
Changing the diet can have a powerful impact on blood cholesterol levels.
The aim with diet is to reduce the intake of harmful fats, and to maintain
a balanced diet with the right amounts of protein, carbohydrate, and
fresh fruits and vegetables. The best diet varies in detail from person
to person, and if a few obvious measures with diet do not reduce high
cholesterol levels, it is often advisable to speak to a renal dietitian.
Foods that are high in cholesterol include dairy products, eggs, and
the fatty parts of red meat. Many processed foods can contain a lot of
cholesterol and the data on the labels should be checked. The type of fats
that increase blood cholesterol levels are often called ‘saturated fats’,
while ‘unsaturated fats’ (which include olive oil) may be less harmful.
It is not just foods containing meat that may be high in fat, biscuits for
example may be high. There is a free app which reads bar codes and can
help to make healthier choices which is available on
http://www.foodswitch.co.uk/
What drugs are used to reduce cholesterol?
If diet and losing weight do not bring the blood cholesterol down to
acceptable levels, drugs may be used. You also need to consider treatment
to slow leak of protein in the urine.
The type of drug most often used has an effect on the liver, reducing the
production of cholesterol. The drugs are called ‘statins’. There are several
different drugs in the statin class, all with names ending in -statin. There
are slight differences between the different statins, and the prescribing
doctor will advise one that should suit someone best.
In many parts of the country there is a preferred statin drug, usually

the most cost-effective, but if this does not suit someone an alternative
may be used. All the statin drugs have side effects. Some people feel
generally unwell with nausea or sickness, and may have to stop the drug
if this persists. Statins can cause aches and pains in the muscles, this is a
serious side effect and should be reported to a doctor immediately.
There are several other types of drug that may either be added to a statin,
or used if a statin is not tolerated. These affect either the absorption of
cholesterol from the food, or the way it is handled in the body.
All drugs used to treat cholesterol require monitoring with blood tests,
and the doses may need to be increased over time to maintain a target
blood level of cholesterol. The drugs are not a substitute for eating a low
fat diet or losing weight or stopping smoking. It is important to keep up
measures across all fronts to combat blood vessel disease.
Who should have drugs to lower cholesterol levels?
In people with kidney disease, statins are prescribed to those who have
a risk of 20% (2 out of 10) or more of a heart attack or stroke over the
next 10 years. This includes anyone who has already had a heart attack
or stroke; otherwise the risk is estimated from age, sex, cholesterol and
blood pressure levels and whether the person has diabetes. National
guidelines on the treatment of cholesterol advice treating cholesterol
with CKD staged 3 and 4. Many guidelines recommend treating cholesterol
if you are above age 50years and have moderate kidney disease (eGFR
<60ml.min); or younger with increased risk factors. In more mild kidney
disease doctors may estimate the risk of heart attacks and strokesl and
depending on this calculation, may consider whether a statin would be
helpful.
This advice is based on the experience of senior kidney specialists as

although statins have been proven to reduce the risk of heart attacks and
stroked in people with kidney disease, those with severe kidney disease
(including transplants) were not included in any of the research.
When researchers have looked at the effect of statins in people who are
treated on dialysis, the benefit is less clear. Kidney doctors now often do
not start statins once dialysis has started but not routinely stop them if
already on it. and sometime even stop them. There is however a clear
benefit with chronic kidney disease not on dialysis and in people with
transplant kidneys.
The National Kidney Federation cannot accept responsibility for
information provided. The above is for guidance only.
Patients are advised to seek further information from
their own doctor.
© 2020-2030 National Kidney Federation (NKF)

All rights reserve
Last reviewed March 2022

Next review March 2025
Reviewed by Dr Oshini Shivakumar ‘Specialist Renal Registrar’

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CHOLESTEROL

Cholesterol is a fatty substance, one of several different types of fat found

Does the cholesterol level matter if I have kidney disease?

Attention needs to be paid to several areas:-

What causes a high cholesterol level?

The cholesterol level depends on several factors. If someone has a high

What is the ideal cholesterol level?

Cholesterol is carried around the body in several different forms and as

LDL (low density lipoprotein) cholesterol is the fraction which is most

What is the best diet for reducing cholesterol?

In many parts of the country there is a preferred statin drug, usually

Who should have drugs to lower cholesterol levels?

This advice is based on the experience of senior kidney specialists as

© 2020-2030 National Kidney Federation (NKF)

Last reviewed March 2022

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