**7. Conclusions**

Reverse epidemiology in cholesterol levels associated with HP introduces a number of questions concerning our understanding of CVD and findings from the Framingham study. The questions becomes whether nephrologists should recommend the same cut-points for HP as is normally used in general populations. Should nephrologists attempt to control malnutrition and inflammation first and focus on lipids once HP have MIC under control? Though statins can help control lipids they may also help control inflammation which in turn may help to regulate appetite and increase albumin levels suggestions that statin therapy may still need to be used in most HP. Finally, more clinical trials are needed to discover if reverse epidemiology is "normal" in HP or simply a new understanding of traditional risk factors.



Table 1. Studies reporting a reverse epidemiology affect regarding cholesterol and HP (2002- Present).
