Another meta-analysis in essence confirmed the results, although the data were analyzed in a Even if statins truly do prevent cardio- vascular events in prevalent dialysis patients, it is clear that the magnitude of any relative reduction in risk is substantially smaller than in earlier stages of CKD.34 However, if this speculative benefit among dialysis patients is confirmed in future studies, the absolute benefit might be comparable to that in people with less severe CKD, due to the higher event rate among dialysis patients.46 The smaller RR reduction noted in SHARP could be due to lower compliance to study drug in the subgroup of dialysis patients. Dialysis patients showed on average a 0.60 mmol/l (23 mg/dl) LDL-C reduction in comparison to the non- dialysis CKD group which outlined a 0.96 mmol/l (37 mg/dl) LDL-C decrease. In summary, these data suggest that despite the exceed- ingly high cardiovascular risk in dialysis patients, it is uncertain whether statin regimens lead to clinical benefit in this population. Therefore, in the judgment of the Work Group, initiation of statin treatment is not recom- mended for most prevalent HD patients. However, patients might reasonably choose statin treatment if they are interested in a relatively small, uncertain reduction in cardiovascular events. Since very high LDL-C might increase the likelihood of benefit from statin in a dialysis patient,47 patients who meet this criterion may be more inclined to receive a statin, recognizing that the benefit remains uncertain. Other factors that might influence a patient s decision to receive statin could include recent MI or greater life expectancy (both favoring treatment), and more severe comorbidity or higher current pill burden (both favoring non-treatment). 2.3.2: In patients already receiving statins or statin/ezetimibe combination at the time of dialysis initiation, we suggest that these agents be continued. 