As there is no direct evidence that statin treatment improves cardiovascular outcomes in patients who require dialysis treatment, this is a weak recommendation. Disconti- nuing statin or statin/ezetimibe treatment is reasonable in patients who place a relatively lower value on a small potential relative reduction in vascular events, and a relatively higher value on the risks of polypharmacy, drug drug interactions, and drug toxicity. SHOULD WE TREAT PATIENTS WITH A STATIN AFTER KIDNEY TRANSPLANTATION? The risk of future cardiovascular events in kidney transplant recipients is substantially elevated compared with people without CKD: the rate of cardiovascular death or non-fatal MI is approximately 21.5 per 1000 patient-years.29 The Assessment of LEscol in Renal Transplantation (ALERT) trial showed that fluvastatin (40 80 mg per day) nonsignificantly reduces the risk of coronary death or non-fatal MI, compared with placebo (RR: 0.83; 95% confidence interval: 0.64 1.06). However, fluvastatin led to a significant 35% relative reduction in the risk of cardiac death or definite non-fatal MI (hazard ratio: 0.65; 95% confidence interval: 0.48 0.88)29 in an unblinded extension study. A significant reduction in the original primary outcome was found after 6.7 years of follow-up. The Work Group judged that the apparent benefits observed in ALERT are consistent with the effects of statins in the general population, suggesting that statins will improve cardiovascular outcomes in kidney transplant recipients. However, the lack of statistical significance in the primary analysis and the fact that only one randomized trial was available both favor a weak recommendation. 