Recommendation 1
We recommend treatment with a statin or statin/ezetimibe combination to reduce CVD events in adults ≥ 50 years with chronic kidney disease not treated with dialysis or a kidney transplant (Strong Recommendation, High Quality Evidence).

Values and preferences
If the preference is to partake in early prevention and long term risk reduction, in subjects < 50 years the absolute risk of events is lower but studies suggests that statins will result in a relative risk reduction similar to those > 50 years. The statin/ezetimibe combination recommendation is based on the SHARP study which utilized 20 mg of simvastatin and 10 mg of ezetimibe.

Recommendation 2
We suggest that lipid lowering therapy not be initiated in adults with dialysis dependent CKD (Conditional Recommendation, Moderate Quality Evidence).

Values and preferences
In younger individuals who may become eligible for kidney transplantation or with a longer life expectancy, statin or statin/ezetemibe therapy may be desirable although high quality studies have not been done in this population.

Recommendation 3
We suggest that lipid lowering therapy be continued in adults already it at the time of dialysis initiation (Conditional Recommendation, Low Quality Evidence).

Values and preferences
This recommendation reflects that fact that a substantial number of patients in SHARP transitioned to dialysis during the study and there was no heterogeneity of results for the population as a whole. The evidence is of low quality overall and there is substantial debate about best practice in this situation.

Recommendation 4
We suggest the use of statin therapy in adults with kidney transplant (Conditional Recommendation, Moderate Quality Evidence).