However, such measurement is minimally invasive, relatively inexpensive, and has potential to improve the health of people with secondary dyslipidemia. In the judgment of the Work Group, children with CKD (and their families) place a high value on this potential benefit and are less concerned about the possibility of adverse events or inconvenience associated with baseline measurement of lipid levels. In the judgment of the Work Group, these considerations justify a strong recommendation despite the low quality of the available evidence. 3.2: In children with CKD (including those treated with chronic dialysis or kidney transplantation), we suggest annual follow-up measurement of fasting lipid levels. (Not Graded) RATIONALE Few data document how frequently the clinical lipid status changes in children with CKD, although it is clear that abnormal levels (once documented) are likely to persist. Unlike adults, growth and development in children have potential to influence lipid levels over time. Therefore, the Work Group recommends that fasting lipid levels be followed in children with CKD to screen for underlying secondary causes of dyslipidemia. The ideal frequency of follow-up for fasting levels of LDL-C, HDL-C and serum TGs is unknown. These levels could be assessed annually in most children with CKD. However, more frequent (or less frequent) follow-up measurements may be appropriate based on the clinical status of the patient, and the potential for such follow-up measurements to influence management.65 Possible changes in management in response to such measurements could include therapeutic lifestyle measures (see Recommendation 6.1) or statin regimens for children with very high LDL-C levels (see Recommendation 4.1). Considerations for International Settings Similar to those for Chapter 1. Suggested Audit Criteria Similar to those for Chapter 1. KEY POINTS K Dyslipidemia is common in children with CKD. K All children with CKD should be screened for dyslipide- mias at presentation. 