Therapeutic lifestyle changes (TLC) should be adopted among all children with CKD. Statin therapy has been shown to reduce LDL-C in children and adolescents ages 8 18 years with no adverse effects on growth, development or sexual maturation However, the follow-up time of the studies was quite variable and safety data in children with CKD are very limited. Data on the benefits of treating LDL-C in children aged o10 years are extremely limited, and chiefly include patients with severe familial hypercholesterolemia or cardiac allografts. In the US, statins are approved for use among adolescent boys and post-menarchal girls ages 10 18 years (age 8 and older for pravastatin) for treatment of elevated LDL-C among those with familial dyslipidemias, family history of premature heart disease and 2 or more cardio- vascular risk factors.7 Four randomized trials have examined drug treatment of dyslipidemia in children with CKD, primarily in children with nephrotic syndrome.71 74 The trials demonstrate that statins lower LDL-C over 7 months to 5 years. No randomized trials have studied clinically relevant outcomes such as cardiovascular events or mortality. There have been 13 statin trials in 1683 children with dyslipidemias and normal kidney function. These trials have demonstrated that statins lower LDL-C by 17-50% (depending on dose) and have modest effects on TGs or HDL-C.75 87 There were only two studies that studied statins in combination with a second drug such as colestipol or ezetimibe.81,85 This is a weak recommendation that reflects the lack of evidence for benefit and safety associated with long-term use. As for all weak recommendations, practitioners should consider the clinical circumstances and the patient s pre- ferences when considering an individual patient. The Work Group further suggests that the patient s age could also be considered when applying this recommendation. 