# N15 — Lipids and Cardiovascular Review

N15 — Lipids and Cardiovascular Review FRONT Front · at the chair

**When:** Admission, medication reconciliation, and a lipid result that needs a decision.

### Do this

1.  Record the lipid-lowering medicine, dose, prescriber, tolerance, and whether it was already being taken when dialysis began.
2.  Bring prior heart attack, stroke, coronary procedures, recent admissions, and medication changes to the clinician reviewing the result.
3.  Confirm why a repeat lipid panel was ordered. Routine monthly LDL targets are not the default dialysis strategy \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N15-Lipids-and-Cardiovascular-Review.html#n15-ref-1)\].
4.  Ask about missed doses, new muscle symptoms, and nonprescription supplements. Route nutrition questions to the renal dietitian.

### Call / escalate

- New chest pain, severe breathlessness, syncope, or stroke symptoms: activate the unit emergency response; do not wait for a lipid result.
- New medication intolerance, an unexpected result, or an unclear post-hospital medication list: request prescriber review.

### Don't

- Do not start, stop, or increase a statin to make one LDL value meet a scorecard. Starting treatment after dialysis begins and continuing an existing treatment are different decisions \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N15-Lipids-and-Cardiovascular-Review.html#n15-ref-1)\].
- Do not substitute over-the-counter fish oil for a prescribed product or dose.

N15 — Lipids and Cardiovascular Review BACK Back · why, and the evidence

### Why

- KDIGO generally advises against initiating statin or statin/ezetimibe in adults already dependent on dialysis, while suggesting continuation when treatment predates dialysis \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N15-Lipids-and-Cardiovascular-Review.html#n15-ref-1)\]. Individual cardiovascular circumstances still need clinician review.
- Large dialysis trials lowered LDL without a significant reduction in their primary cardiovascular outcomes. This is why an LDL number alone is not a treatment instruction \[[2](https://urinenephrology.org/mastery/maintenance-hd/nursing/N15-Lipids-and-Cardiovascular-Review.html#n15-ref-2),[3](https://urinenephrology.org/mastery/maintenance-hd/nursing/N15-Lipids-and-Cardiovascular-Review.html#n15-ref-3)\].
- A quality review should capture symptoms, treatment tolerance, and the documented prevention plan, not just whether a laboratory number is in range.

### Bring this to the review

Current medicine and tolerance; when it began; cardiovascular history; reason for the lipid test; result and prior value; the decision needed from the prescriber.

### Go deeper

- [Cardiometabolic Monitoring in Maintenance Hemodialysis](https://urinenephrology.org/mastery/maintenance-hd/cardiometabolic-monitoring-hd.html)
- [Inflammation and Fish Oil (PISCES) in Hemodialysis](https://urinenephrology.org/mastery/maintenance-hd/inflammation-fish-oil-hd.html)
- [Complete screening and health maintenance white paper](https://urinenephrology.org/mastery/dialysis-advanced/screening-tests-hemodialysis.html)
- [N9 · Monthly labs overview](https://urinenephrology.org/mastery/maintenance-hd/nursing/N9-Monthly-Labs.html)

### References

1.  [KDIGO lipid guideline summary. Kidney Int. 2014. PMID: 24552851](https://pubmed.ncbi.nlm.nih.gov/24552851/)
2.  [4D trial. N Engl J Med. 2005. PMID: 16034009](https://pubmed.ncbi.nlm.nih.gov/16034009/)
3.  [AURORA trial. N Engl J Med. 2009. PMID: 19332456](https://pubmed.ncbi.nlm.nih.gov/19332456/)

Adapted from the linked Clinical Mastery reviews; updated September 27, 2026. For education; the physician's written order and the unit protocol always govern.


---

[Website version](https://urinenephrology.org/mastery/maintenance-hd/nursing/N15-Lipids-and-Cardiovascular-Review.html) · Markdown synchronized October 3, 2026.