There is increasing evidence for the role of hyperlipidemia as a contributing factor to the progression of chronic renal disease. Experimental studies in animal models suggest that lipids might be important modulators in progressive renal disease. On one hand maneuvers designed to elevate cholesterol worsen renal disease while reduction of lipid-lowering agents have demonstrated beneficial effects. In humans, correcting abnormalities in lipid metabolism with antilipemic therapy may help slow the rate of functional decline in patients with progressive renal disease as well as reduce the frequency of acute rejection after renal transplantation. However, large controlled clinical trials examining the effect of lipid-lowering strategies on progression of renal disease have not been carried out. Further clinical trials delineating the precise role of antilipemic agents in treating patients with renal disease appears warranted.