Ezetimibe Use in Chronic Kidney Disease

Guideline-Based Recommendations for Ezetimibe in CKD

The Kidney Disease: Improving Global Outcomes (KDIGO) strongly recommends (Grade 1A) treatment with either a statin alone or a statin/ezetimibe combination for adults ≥50 years with eGFR <60 mL/min/1.73 m² not on dialysis 1, 2, 4
The European Society of Cardiology (ESC/EAS 2016) indicates that statin/ezetimibe combination is appropriate for non-dialysis-dependent CKD patients 3
For adults ≥50 years with CKD stages 1-2, statin monotherapy is recommended (Grade 1B), with ezetimibe reserved as add-on therapy if needed 1, 2, 4
In dialysis patients, statins or statin/ezetimibe should NOT be initiated (Grade 2A) 2, 4
However, if patients are already receiving these agents at dialysis initiation, continuation is suggested (Grade 2C) 2, 4

If age ≥50 years AND eGFR <60 mL/min/1.73 m² (stages 3a-5) AND not on dialysis → Initiate statin or statin/ezetimibe combination 1, 2
If age ≥50 years AND eGFR ≥60 mL/min/1.73 m² (stages 1-2) → Initiate statin monotherapy 1, 2
For CKD stages 3a-5, ezetimibe can be used upfront with a statin or added if LDL-C remains elevated on statin monotherapy 1

The only CKD population where ezetimibe initiation is NOT recommended is dialysis-dependent patients without pre-existing atherosclerotic CVD, due to limited evidence of benefit in this specific group 2, 4, 3