The cause of death in the majority of patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) is accelerated cardiovascular disease and not renal failure per se, suggesting a role for statin therapy in this setting. During the past 6 years three large, randomized, placebo-controlled studies of three different statins have been conducted in the dialysis population-but two of these studies did not demonstrate any benefits of statin therapy, and the third study showed only marginally positive results. To understand why statins have failed to reduce cardiovascular events in patients with ESRD, the basic mechanisms underlying the pathogenesis of dyslipidemia in CKD must be critically examined. The observed negative results in the clinical trials of statin therapy might also reflect the biomarkers and targets that were chosen to be evaluated. The characteristics of dyslipidemia in patients with CKD not yet requiring dialysis treatment differ markedly from those of individuals with established ESRD and form the basis for therapeutic recommendations. The potential adverse effects associated with statin therapy are important to consider in the management of dyslipidemia in patients with CKD.