As mentioned earlier, given that evidence of clinical benefit is greater for statins than for fibrates, the Work Group recommends that statins be prescribed in preference to fibrates when clinicians are trying to choose between the two classes of medication. Statins are contraindicated in pregnant or breast-feeding females; in people with active liver disease; and in people with transaminase levels that are three times or more the upper limit of normal. There is no evidence that the risk of liver dysfunction differs in people with CKD, as compared to those without. Regardless of CKD severity, the Work Group recommends that baseline levels of transaminases be measured before initiating statin treatment. Routine follow- up measurements of transaminases are not recommended, given the low frequency of abnormalities among people without abnormal values at baseline.33 Similarly, the Work Group does not recommend measurement of CK levels at baseline or during follow-up, unless the patient develops symptoms suggestive of myopathy. 2.1.1: In adults aged Z50 years with eGFR o60 ml/min/ but not treated with chronic dialysis or kidney transplantation (GFR categories G3a-G5), we recommend treatment with a statin or statin/ ezetimibe combination. (1A) RATIONALE Data on the effects of statins and statin/ezetimibe combina- tion in non-dialysis dependent adults with eGFR o60 ml/ are presented in Supplemental Tables 6 10, 15 17 online. The SHARP trial included 9270 participants with CKD (mean eGFR of 27 ml/min/1.73 m2 ) to receive simvastatin 20 mg plus ezetimibe 10 mg daily or placebo, and followed them for 5 years.14 Thirty-three percent of participants (n 3023) were receiving dialysis at randomiza- tion and 23% (n 2094) had diabetes. 