(1C) RATIONALE have at least 10-fold higher risk for CVD mortality compared to the Many recent studies document the prevalence of CVD risk factors in children with CKD. However, due to limited follow-up, few studies demonstrate the association of dyslipidemia with clinical CVD events in adolescents or young adults, especially in the setting of CKD. In the general pediatric population, lipid levels in childhood are predictive of future lipid levels and subsequent The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study shows that initial fatty streaks seen in adolescents with normal kidney function develop into atheromatous plaques in young adults.56 Over 50% of children 10-14 years old had early fatty streaks, and 8% had fibrous plaques, thus confirming that atherosclerosis begins in childhood.56 Additional longitudinal studies demonstrate an association between childhood lipid levels and adult onset coronary artery disease.57 59 Moreover, this atherosclerotic process is likely accelerated in nephrotic syndrome, proteinuric states and chronic kidney disease due to abnormal lipid metabolism and other atherogenic risk factors, thus putting children and adolescents at risk for developing CVD as they age into adulthood. In the Bogalusa Heart Study, body mass index, LDL-C, and systolic blood pressure were associated with atherosclerotic disease of the aorta and coronary vessels of children.56,57 Recent studies of subclinical atherosclerotic CVD in children with familial hypercholesterolemia found an increase in intimal medial thickness of the aorta and carotid arteries compared to that of healthy young children.60 Thus, atherosclerotic disease appears to begin in childhood, and dyslipidemia in children may play an important role in the early pathogenesis of atherosclerosis. In children with CKD, the relationship between dyslipi- demias and subsequent atherosclerotic clinical events is not known due to short follow-up in observational studies or clinical trials. 