How do you approach deprescribing or continuing statin therapy in older adults with end-stage kidney disease who are initiating dialysis?

My practice in older adults starting dialysis is no different from that of younger patients starting dialysis. If the patient is on a statin, I do not discontinue it. If the patient is not on a statin, I do not start it when they begin dialysis, as there is no strong evidence that it reduces cardiac events or improves cardiac mortality for those on dialysis. If an elderly patient on dialysis has a cardiac event, they are often started on a statin by the cardiology team. In these cases, I will continue it.