Guidelines for the general population recommend that (among patients receiving statin treatment), the dose of statin is titrated to achieve the target level of LDL-C, which in turn is determined by each patient s presumed coronary This approach is widely accepted, although it has never been shown to lead to clinical benefit in a RCT. Instead, existing randomized trials have compared statin and placebo, or compared higher and lower doses of statin (regardless of achieved LDL-C). Taken together, these trials suggest that higher statin doses produce greater clinical benefits, but at the expense of an increased risk of adverse events. CKD patients are at high risk of medication-related adverse events, perhaps because of the reduced renal excretion, frequent polypharmacy and high prevalence of comorbidity in this population. Therefore, reduced doses of statins are generally recommended for patients with advanced CKD. The SHARP trial addressed this issue by using lower dose simvastatin (20 mg/day) and adding ezetimibe (10 mg/day) to achieve an average LDL-C reduc- tion of about 0.83 mmol/l (32 mg/dl), during a 4.9-year period of treatment.14 Subgroup analysis of the TNT trial reported that atorvastatin 80 mg/day reduced major cardiovascular events Table 3 | Rate of coronary death or non-fatal MI (by age and eGFR) Rate (95% CI) of coronary death or non-fatal MI (per 1000 patient-years) Overall Male Female Abbreviations: CI, confidence interval; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; MI, myocardial infarction. Data are unadjusted rates from 1,268,029 participants in the Alberta Kidney Disease cohort. People with diabetes, MI, and other cardiovascular disease were included. Data do not apply to people with kidney transplants. 