Background: Dialysis dependent or non-dependent chronic kidney disease (CKD) patients are candidates for kidney transplantation. KDIGO recommended lipid lowering treatment in dialysis non-dependent CKD patients, but not in patients who have already initiated dialysis because of no benefit on survival. We hypothesized that LDL-cholesterol level may be a difference between patients undergoing peritoneal dialysis and dialysis non-dependent CKD patients at the time of kidney transplantation.
Methods: We included 1572 kidney transplant patients who had enrolled in a nationwide prospective cohort of Korea. Patients were divided into 2 groups by LDL-cholesterol level (lower LDL-C, <100 mg/dl vs higher LDL-C, ≥100 mg/dl). We examined the association between LDL-cholesterol groups and dialysis modality or dialysis non-dependent CKD using univariate and multivariate logistic regression analysis.
Results: The 1,476 kidney transplant patients were 48.0±11.6 years old and included 41.5% female, 22% diabetes. Before kidney transplantation, 1,090 patients underwent hemodialysis, 236 patients peritoneal dialysis, and 246 patients dialysis non-dependent CKD. Mean LDL-cholesterol was 70.7 (±17.6, SD) mg/dl and 126.7 (±25.7, SD) mg/dl in lower LDL-C and higher LDL-C, respectively. Multivariate logistic regression analysis showed that peritoneal dialysis patients had increased odds of higher LDL-C compared to dialysis non-dependent CKD patients at the time of kidney transplantation (odds ratio, 2.10; 95% confidential interval, 1.39-3.18). Peritoneal dialysis patients not used lipid lowering treatment with statin had significantly increased odds of higher LDL-C (odds ratio, 2.12; 95% confidential interval, 1.32-3.42 compared to dialysis non-dependent CKD patients not using statin). 
Conclusion: Patients undergoing peritoneal dialysis had higher LDL-cholesterol than dialysis non-dependent CKD patients at the time of kidney transplantation. This tendency remained when statin was not used in peritoneal dialysis patients. Thus, we suggest that CKD patients who were candidates of kidney transplant initiate statin before dialysis.