However, the lack of statistical significance in the primary analysis and the fact that only one randomized trial was available both favor a weak recommendation. review C Chapters 3 and 4 | Assessment of lipid status and pharmacological cholesterol treatment in children with CKD Grade 1C 3.1: In children with newly identified CKD (including those treated with chronic dialysis or kidney transplantation), we recommend evaluation with a lipid profile (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides) Not graded 3.2: In children with CKD (including those treated with chronic dialysis or kidney transplantation), we suggest annual follow-up measurement of fasting lipid levels 2C 4.1: In children o18 years of age with CKD (including those treated with chronic dialysis or kidney transplantation), we suggest that statins or statin/ezetimibe combination not be initiated THE ATHEROSCLEROTIC PROCESS BEGINS IN CHILDHOOD Many studies document the prevalence of dyslipidemia among children with CKD and end stage renal disease.30,31 As in adults, the pattern of dyslipidemias in children with CKD is greatly influenced by the underlying pathogenesis and duration of CKD, severity of proteinuria, and treatment.30,31 In children or adolescents with CKD, the relationship between dyslipidemias and subsequent atherosclerotic clinical events is not known owing to short follow-up in observa- tional studies or clinical trials. The Pathobiological Determi- nants of Atherosclerosis in Youth (PDAY) study shows, in adolescents with normal kidney function, that atherosclerosis begins in childhood.32 This atherosclerotic process is likely accelerated in nephrotic syndrome, proteinuric states, and chronic kidney disease (CKD) owing to abnormal lipid metabolism and other atherogenic risk factors. 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. 