The frequency of lipid abnormalities suggests that clinicians should measure lipid levels at baseline in children with CKD to screen for underlying secondary causes of dyslipidemia. Children with CKD (and their families) place a high value on this potential benefit and are less concerned about the possibility of adverse events or inconvenience associated with baseline measurement of lipid levels. In the judgment of the Work Group, these considerations justify a strong recom- mendation despite the low quality of the available evidence. Children with very severely increased hypertriglyceridemia (411.3 mmol/l (41000 mg/dl)) should be referred to a pediatric lipid specialist for management and to rule out familial hypertriglyceridemia or rare, inherited disorders such as lipoprotein lipase deficiency or apolipoprotein C-II deficiency. UNLIKE ADULTS, GROWTH AND DEVELOPMENT IN CHILDREN HAVE THE POTENTIAL TO INFLUENCE LIPID LEVELS OVER TIME The ideal frequency of follow-up for fasting levels of LDL-C, HDL-C, and serum TGs is unknown. More frequent (or less frequent) follow-up measurements may be appropriate based on the clinical status of the patient, and the potential for such follow-up measurements to influence manage- ment.33 Possible changes in management in response to such measurements are likely. LACK OF EVIDENCE FOR BENEFIT AND SAFETY PRECLUDES STATIN TREATMENT IN CHILDREN OR ADOLESCENTS Clinical trials of dyslipidemias in children are limited given the rapid transitions from CKD to dialysis and/or transplant, which complicates trial design, recruitment, and analyses. Four randomized trials have examined drug treatment of dyslipide- mia primarily in children with nephrotic syndrome, but no trials have studied clinically relevant outcomes.34 37 These trials demonstrate that statins lower LDL-C over 7 months to 5 years, but no dose escalation has been carried out. There have been 13 placebo-controlled trials of statins in 1683 children with dyslipidemias and normal kidney function. 