Since that time, all these studies have been published and most have been synthesized in two recent meta-analyses in order to bring all information into context. In 2007 KDOQI issued Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease and included a set of guidelines on Manage- ment of Dyslipidemia in Diabetes and Chronic Kidney The guidelines adopted trends in treating people with very high risk and recommended treatment to target low-density lipoprotein cholesterol (LDL-C) of o2.6 mmol/l (o100 mg/dl) for people with diabetes and eGFR cate- gories G1-G4. The target of o1.8 mmol/l (o70 mg/dl) was considered a therapeutic option. The guidelines included the results of the 4D study, which to the surprise of many, demonstrated that lowering LDL-C with atorvastatin in hemodialysis (HD) patients with type 2 diabetes did not produce statistically significant reductions in the primary outcome measure. The study had strong impact on a recommendation for HD patients which stated that treat- ment with a statin should not be initiated in patients with type 2 diabetes on maintenance HD therapy who do not have a specific cardiovascular indication for treatment. Four years later, AURORA was hoped to provide clarification of whether LDL-C lowering with rosuvastatin would offer any benefit to HD patients. Like 4D, the main results of AURORA were negative. Since then, multiple hypotheses have been raised to explain these unexpected findings. A different cardiovascular pathology with vascular stiffness, calcification, structural heart disease, and sympathetic overactivity contributing to an increasing risk for cardiac arrhythmia and heart failure was deemed responsible. The results of SHARP, a very large inter- national RCT, is highly relevant to this discussion. SHARP showed a significant decrease in major atherosclerotic events with simvastatin and ezetimibe compared with placebo in dialysis-dependent and non-dialysis-dependent patients. 