However, since most do not explicitly consider the presence of CKD, which would be expected to increase coronary risk for any given set of traditional cardiovascular risk factors, such overestimation should be less pronounced in CKD populations. Patients whose 10-year risk of coronary death or non-fatal MI is o10% could choose to receive statin treatment if they placed relatively more value on a small absolute reduction in the risk of cardiovascular events, and relatively less value on minimizing the risks of polypharmacy and drug toxicity. On the other hand, patients valuing the potential benefits of statin treatment to a lesser extent than the potential harms might choose not to receive statin treatment even if their 10-year risk of coronary death or non-fatal MI is 410%. 2.3.1: In adults with dialysis-dependent CKD, we suggest that statins or statin/ezetimibe combination not be RATIONALE There are three large-scale RCTs of statin treatment that enrolled dialysis patients. Data from these trials are presented in Supplemental Tables 11 13, 17 online. The 4D Study (Die Deutsche Diabetes Dialyse Studie) The 4D, a multicenter, double blind, randomized trial assigned 1255 HD patients with type 2 diabetes to receive 20 mg of atorvastatin daily or placebo.43 After 4 weeks of treatment, atorvastatin reduced the median LDL-C level by difference in LDL-C level was maintained throughout the treatment period. During median follow-up of 4 years, 469 patients (37%) reached the primary endpoint (a composite of cardiac death, nonfatal MI, and fatal and nonfatal stroke): 226 assigned to atorvastatin and 243 assigned to placebo (RR 0.92; 95% CI 0.77 1.10; p 0.37). Atorvastatin had no effect on the single components of the primary endpoint with the exception of fatal stroke, in which RR was 2.03 (95% CI 1.05- 3.93; p 0.04). 