UP FRONT MATTERSLipid Abnormalities and Cardiovascular Risk in Renal DiseaseRitz, Eberhard; Wanner, Christoph Author Information Department of Internal Medicine, Division of Nephrology, University of Heidelberg, Heidelberg, Germany; and Department of Internal Medicine, Division of Nephrology, University of Wu[Combining Diaeresis]rzburg, Wu[Combining Diaeresis]rzburg, Germany Correspondence: Dr. Eberhard Ritz, Nierenzentrum, Im Neuenheimer Feld 162, D-60120 Heidelberg, Germany. Phone: 49-6221-601705; Fax: 49-6221-603302; E-mail: [email protected] Journal of the American Society of Nephrology 19(6):p 1065-1070, June 2008. | DOI: 10.1681/ASN.2007101128 Buy Metrics Abstract The recent 4D study failed to provide definitive evidence for benefit of statin use in type 2 diabetics on dialysis. This finding stands in stark contrast to a number of other observations in patients with early stages of chronic kidney disease where substantial benefit of statins had been documented. Here we discuss some potential explanations for the unexpected finding of the 4D study and for the negative association between below average total cholesterol and vascular mortality among dialysis patients. Admittedly, in the absence of definite evidence in dialysis patients, we still conclude that the administration of statins is appropriate in patients with manifest coronary disease. Copyright © 2008 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.