Statin plus ezetimibe therapy was associated with a significant 17% RR reduction of the primary outcome of major atherosclerotic events (coronary death, MI, non-hemorrhagic stroke, or any revascularization) compared with placebo (HR 0.83; 95% CI 0.74 0.94). SHARP indicated that risk for the primary outcome of major atherosclerotic events other than death was reduced by simvastatin/ezetimibe among a wide range of patients with CKD. Combination treatment did not significantly reduce the risk of the primary outcome in the subgroup of over 3000 patients treated with dialysis at baseline. A systematic review pooling data from all available randomized trials done in CKD populations reported significant heterogeneity between dialysis and non-dialysis patients for the benefit of statins on major cardiovascular events (HR for dialysis 0.96; 95% CI 0.88 1.03; HR for non- dialysis 0.76; 95% CI 0.72 0.79; p for heterogeneity When findings from SHARP, 4D and AURORA are considered together, the clinical benefit of statins (alone or in combination with ezetimibe) in prevalent dialysis patients is uncertain. Another meta-analysis in essence confirmed the results, although the data were analyzed in a Even if statins truly do prevent cardio- vascular events in prevalent dialysis patients, it is clear that the magnitude of any relative reduction in risk is substantially smaller than in earlier stages of CKD.34 However, if this speculative benefit among dialysis patients is confirmed in future studies, the absolute benefit might be comparable to that in people with less severe CKD, due to the higher event rate among dialysis patients.46 The smaller RR reduction noted in SHARP could be due to lower compliance to study drug in the subgroup of dialysis patients. 