The order of recommendations in the guideline was based on the order used in the 2003 K/DOQI publication, and it presents recommendations on assessment of lipid status before those related to treatment. RECOMMENDATIONS RELATING TO PHARMACOLOGICAL CHOLESTEROL-LOWERING TREATMENT IN ADULTS Background To maximize the ratio of benefits to harm, future coronary risk is considered an important potential determinant of the decision to prescribe statin treatment.4 In people without kidney disease, low-density lipoprotein cholesterol (LDL-C) is often used as a proxy for future risk, as LDL-C levels are independently associated with the risk of atherosclerotic events.5 However, the relative risk (RR) reduction associated with statin use is approximately constant across a broad range of baseline LDL-C levels, suggesting that absolute benefit from statin treatment is proportional to baseline coronary risk rather than baseline LDL-C. LDL-C is not suitable for assessing coronary risk in people with CKD: although higher levels of LDL-C are associated with higher risk, dialysis patients with very low levels of LDL-C and total cholesterol are at a very high risk of all-cause and cardiovascular mortality,5 9 likely because of coexisting malnutrition and inflammation.10,11 Among people with CKD but without kidney failure, the excess risk associated with increased LDL-C decreases in parallel with estimated glome- rular filtration rate (eGFR).12 The weaker association between LDL-C and coronary risk among those with lower levels of eGFR (who are at the highest risk of myocardial infarction (MI) and other vascular events) suggest that it should not be used to identify the CKD patients who should receive statin treatment. Future cardiovascular risk is often assessed using the 10-year incidence of coronary death or non-fatal MI, numerically equivalent to the rate of such events per 1000 patient-years. 