In the judgment of the Work Group, these considerations favor an ungraded statement. Chapter 2 | Pharmacological cholesterol-lowering treatment in adults Grade but not treated with chronic dialysis or kidney transplantation (GFR categories G3a G5), we recommend treatment with a statin or statin/ezetimibe combination 1B 2.1.2: In adults aged X50 years with CKD and eGFR X60ml/min (GFR categories G1 G2), we recommend treatment with a statin 2A 2.2: In adults aged 18 49 years with CKD but not treated with chronic dialysis or kidney transplantation, we suggest statin treatment in people with one or more of the following (2A): known coronary disease (myocardial infarction or coronary revascularization) diabetes mellitus prior ischemic stroke estimated 10-year incidence of coronary death or non-fatal myocardial infarction 410% THE SHARP STUDY HAD A LARGE IMPACT ON A STRONG RECOMMENDATION IN GFR CATEGORIES G3A G5 As the absolute risk of future coronary events is consistently 410 per 1000 patient-years in people with non-dialysis- dependent CKD (eGFR o60 ml/min per 1.73 m2 ) who are aged X50 years, knowledge of LDL-C is not required to gauge average coronary risk in these people. Although multivariate prediction instruments might yield more precise estimates of risk for individuals, the Work Group felt that the simplicity of an age-based approach would enhance uptake of the guideline while allowing sufficiently accurate risk prediction. The Study of Heart and Renal Protection (SHARP) indicated that simvastatin/ezetimibe combination therapy reduces the risk of major atherosclerotic events (coronary death, MI, non-hemorrhagic stroke, or any revascularization) compared with placebo in people with GFR categories G3a G5.22 These data are supported by post hoc analyses of randomized trials of statin versus placebo that focus on the subset of participants with CKD at baseline. 