The role of anti-hyperlipidemic therapy remains of key importance in the treatment of atherosclerotic disease. Moreover, given an already exaggerated predisposition for vascular disease at baseline, there is a preponderance of data that show management of hyperlipidemia is especially important in patients with chronic kidney disease. This is a concise, up-to-date review of lipid physiology, alterations in lipid concentrations with progressive renal failure, and currently available and emerging hyperlipidemic treatment options. Specifically, the roles of these therapies in patients with chronic kidney disease are reviewed.