The benefit of statin monotherapy appears similar in people with and without albuminuria.24,25 Given these data, the high cardiovascular risk among people with CKD and eGFR categories G1 G2, the large body of evidence supporting the efficacy of statins in the general population, and the lack of justification for a new trial performed specifically in people with CKD and eGFR categories G1 G2, the Work Group judged that a strong recommendation was appropriate. Chapter 2 | continued: Pharmacological cholesterol-lowering treatment in adults Grade 2A 2.3.1: In adults with dialysis-dependent CKD, we suggest that statins or statin/ezetimibe combination not be initiated 2C 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 2A 2.4: In adult kidney transplant recipients, we suggest treatment with a statin WHY DID THE WORK GROUP NOT RECOMMEND INITIATION OF STATIN TREATMENT IN DIALYSIS PATIENTS? Three large trials22,26,27 have failed to show a conclusive benefit of statin treatment (alone or in combination) among prevalent dialysis patients raising the hypo- thesis that inadequate statistical power was responsible for the apparent lack of benefit. Nonetheless, it is clear that even if statins do prevent cardiovascular events in prevalent dialysis patients, the magnitude of any relative reduction in risk is substantially smaller than in earlier stages of CKD.23 Therefore, in the judgment of the Work Group, initiation of statin treatment is not recommended for most prevalent hemodialysis patients. However, patients might decide to receive statin treatment if they are interested in a relatively uncertain and small reduction in cardiovascular events. 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. 