Presence of albuminuria with reduced eGFR multiplies this CVD risk. The risk is graded and increases with severity of eGFR impairment, with observed threshold of risk beginning around 75 , whereas the risk associated with albuminuria is linear.S4.5.4-6 Trials show abso- lute benefit from statin use, and this benefit is consistent across eGFR stages. However, the RRR per LDL-C lowering may be lower with more advanced CKD. Albuminuria is independently associated with CVD risk. However, the one trial done for primary prevention in persons with albu- minuria and preserved eGFR had too few events to be conclusive.S4.5.4-7 2. According to this recommendation, in patients with CKD who are currently taking a statin, it may be reasonable to continue the statin. In sup- port of this, in the SHARP trial (Study of Heart and Renal Protection) (simvastatin plus ezetimibe versus placebo), >30% of persons transitioned to After weighting for subgroup-spe- cific reductions in LDL-C was performed, the pro- portional effects on major atherosclerotic events were similar in patients on dialysis and those who were not on dialysis. 3. Although persons on dialysis have the high- est absolute risk of events (and thus poten- tial for higher ARR), the proportion of deaths thought to be due to atherosclerotic events is The lack of benefit in RCTs with statin initiation among persons on dialysis raises the question of competing risks. Unfortunately, there CLINICAL STATEMENTS AND GUIDELINES are not enough data to distinguish the potential for benefit from statin therapy between those on peritoneal dialysis and those on hemodialysis. 4.5.5. Adults With Chronic Inflammatory Disorders and HIV Recommendations for Adults With Chronic Inflammatory Disorders and HIV Referenced studies that support recommendations are summarized in Online Data Supplement 39. 