2.3.2: In patients already receiving statins or statin/ezetimibe combination at the time of dialysis initiation, we suggest that these agents be continued. (2C) RATIONALE SHARP, 4D and AURORA do not directly address the question of whether statins should be discontinued in patients initiating dialysis, who may be systematically different from prevalent dialysis patients. However, 2141 (34%) of SHARP patients without kidney failure at baseline commenced dialysis during the trial and were analyzed in the non-dialysis group in which overall benefit was observed.14 In the judgment of the Work Group, it is reasonable to continue statins in patients who are already receiving them at the time of dialysis initiation, recognizing that the magnitude of clinical benefit may be lower than in patients with non-dialysis-dependent CKD. Physicians should con- sider periodically reviewing the clinical status of dialysis patients and revisiting the decision to prescribe statins as required. Given the lack of direct evidence that statin treatment is beneficial in dialysis patients, this recommendation is graded as weak. Discontinuation of statin or statin/ezetimibe may be warranted in patients who place a relatively low value on a small potential relative reduction in cardiovascular events, and a relatively high value on the risks of polypharmacy and drug toxicity. 2.4: In adult kidney transplant recipients, we suggest treatment with a statin. 