Adults With CKD Recommendations for Adults With CKD Referenced studies that support recommendations are summarized in Online Data Supplements 36 to 38. COR LOE Recommendations IIa B-R In adults 40 to 75 years of age with LDL-C are at 10-year ASCVD risk of 7.5% or higher, CKD not treated with dialysis or kidney transplantation is a risk-enhancing factor and initiation of a moderate-intensity statin or moderate-intensity statins combined with ezetimibe can be useful.S4.5.4-1,S4.5.4-2 IIb C-LD In adults with advanced kidney disease that requires dialysis treatment who are currently on LDL-lowering therapy with a statin, it may be reasonable to continue the statin.S4.5.4-2 III: No Benefit B-R In adults with advanced kidney disease who require dialysis treatment, initiation of a statin is not recommended.S4.5.4-3,S4.5.4-4 Synopsis CKD is a risk-enhancing factor for ASCVD. In risk dis- cussion with intermediate-risk patients, the presence of CKD favors initiation of statin therapy. In adults with advanced kidney disease requiring dialysis treatment who are currently on pharmacological LDL-lowering therapy with a statin, it may be reasonable to continue In adults with CKD that requires dialysis treatment, initiation of a statin is not recommended on the basis of 2 large-scale RCTs.S4.5.4-3,S4.5.4-4 Recommendation-Specific Supportive Text not on dialy- sis) and presence of albuminuria (albumin-to- creatinine ratio 30 mcg/mg) are independently associated with elevated risk of ASCVD. Hence, in intermediate-risk patients, CKD counts as a risk- enhancing factor. According to some studies,S4.5.4-5 the cardiovascular risk for persons with reduced eGFR may be as high as that observed among patients with diabetes mellitus and no CKD. Presence of albuminuria with reduced eGFR multiplies this CVD risk. 