Supplementary Material for: Dyslipidemia in Chronic Kidney Disease: Contemporary Concepts and Future Therapeutic Perspectives

<b><i>Background:</i></b> Chronic kidney disease (CKD) is an increasingly prevalent disease state met with great morbidity and mortality primarily resulting from the high incidence of adverse cardiovascular outcomes. Therapeutic strategies in this patient population aim at controlling modifiable cardiovascular risk factors, including dyslipidemia. <b><i>Summary:</i></b> In this review article, we first provide the latest pathophysiologic evidence regarding the altered dyslipidemia pattern in CKD, followed by its contemporary management according to the latest guidelines. Moreover, we present the current progress regarding the emerging therapeutic strategies. <b><i>Key Messages:</i></b> The presence of renal impairment leads to alterations in cholesterol structure, metabolism, and reverse transport paired with increased oxidative stress. Statins remain the cornerstone of dyslipidemia management in patients with kidney dysfunction who are at risk for cardiovascular events. However, their efficacy is debatable in end-stage renal disease under renal replacement therapy. Therefore, novel treatment approaches aiming at hypertriglyceridemia, proprotein convertase subtilisin/kexin type 9, and lipoprotein(a) are under rigorous investigation while the research of gut microbiome might provide additional mechanistic and therapeutic insight.

**背景：** 慢性肾脏病（Chronic Kidney Disease, CKD）是一种患病率持续攀升的疾病，其伴随极高的致残率与死亡率，这主要源于不良心血管事件的高发。该患者群体的治疗策略旨在控制可干预的心血管危险因素，包括血脂异常（dyslipidemia）。

**总结：** 在本篇综述中，我们首先阐述了慢性肾脏病患者血脂异常模式改变的最新病理生理学证据，随后结合最新指南介绍了当前的规范化管理方案。此外，我们还介绍了新兴治疗策略的最新研究进展。

**核心观点：** 肾功能损害会改变胆固醇的结构、代谢及逆向转运过程，并伴随氧化应激水平升高。他汀类药物仍是合并心血管事件风险的肾功能不全患者血脂异常管理的基石。然而，对于接受肾脏替代治疗的终末期肾病（end-stage renal disease, ESRD）患者，他汀类药物的疗效尚存争议。因此，针对高甘油三酯血症（hypertriglyceridemia）、前蛋白转化酶枯草溶菌素9（proprotein convertase subtilisin/kexin type 9）以及脂蛋白(a)（lipoprotein(a)）的新型治疗方案正处于严格的研究阶段；与此同时，肠道微生物组（gut microbiome）的相关研究或可提供额外的机制研究与治疗新思路。