As high LDL-C might increase the likelihood of benefit from statin in a dialysis patient,28 patients who meet this criterion may be more interested in receiving statin treatment, recognizing that the benefit remains speculative. Other factors that might influence a patient s decision to receive statin treatment could include a recent cardiovascular event (MI or stroke) or longer anticipated life expectancy (both of which would favor treatment), and more severe comorbidity or higher current medication burden (both of which would favor lack of treatment). WHY SHOULD STATIN TREATMENT NOT BE STOPPED WHEN THE PATIENT NEW ON DIALYSIS HAS RECEIVED TREATMENT IN EARLIER STAGES OF CKD? Available evidence does not directly address whether statins should be discontinued in incident dialysis patients, who may be systematically different from those who are already prevalent on dialysis (such as those included in the major trials of lipid-lowering treatment in dialysis patients). However, 2141 (34%) of SHARP patients without kidney failure at baseline commenced dialysis during the trial and were considered as non-dialysis patients; overall benefit was observed in this latter group.22 The Work Group judged that it is reasonable to continue statins in patients who are already receiving them at the time of dialysis initiation, recognizing that they may lead to less clinical benefit than in patients without kidney failure. Physicians should consider perio- dically reviewing the clinical status of dialysis patients and revisiting the decision to prescribe statins as required. As there is no direct evidence that statin treatment improves cardiovascular outcomes in patients who require dialysis treatment, this is a weak recommendation. 