However, the nominal lack of statistical significance in the primary analysis and the existence of a single randomized trial favor a weak recommendation. The age at which statin treatment should begin in kidney transplant recipients is uncertain: the risk of coronary events is age-dependent, and ALERT did not enroll participants younger than 30 years, However, ESRD treated by kidney transplantation is a chronic disease, with cardiovascular risk expected to increase over time even in the presence of optimal graft function. In the judgment of the Work Group, these considerations warrant treatment in all adult kidney transplant recipients. However, younger patients (for example, those o30 years and without traditional cardio- vascular risk factors) could choose not to receive statin treatment if they placed relatively less value on a small absolute reduction in the risk of cardiovascular events, and relatively more value on minimizing the risks of poly- pharmacy and drug toxicity. Considerations for International Settings In some Asian countries, doses of statins tend to be lower than those used in Western countries, due to concern about drug toxicity and clinical trial data indicating that such doses safely and improve clinical outcomes.52,53 There- fore, physicians practicing in such countries may choose to prescribe lower doses than recommended in Table 4. Suggested Audit Criteria K One year before and after the publication of this guide- line, assess the proportion of non-dialysis-dependent that receive treatment with a statin or statin/ezetimibe combination. K One year before and after the publication of this guide- line, assess the proportion of adults aged Z50 years with that receive treat- ment with a statin. K One year before and after the publication of this guideline, assess the proportion of adult kidney trans- plant recipients that receive treatment with a statin. 