Benefits and Harms of Statin Therapy for Persons With Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Study Questions:

Is statin therapy beneficial for patients with chronic kidney disease?

Methods:

This systematic review and meta-analysis included randomized trials identified through Cochrane and EMBASE databases through February 2012. Trials were included if they compared a statin arm to placebo, no treatment, or another statin. Outcomes had to include mortality and cardiovascular outcomes. A total of 50 randomized trials from an earlier meta-analysis were included. An additional 2,580 citations were reviewed; of these, 89 separate trials were reviewed. In total, 80 trials were included in this current meta-analysis.

Results:

A total of 51,099 patients from 80 trials were included. The effects of statin therapy varied by stage of renal disease. Among patients not receiving dialysis, statin therapy was associated with reductions in all-cause mortality (relative risk [RR], 0.81; 95% confidence interval [CI], 0.74-0.88), cardiovascular mortality (RR, 0.78; CI, 0.68-0.89), and cardiovascular events (RR, 0.76; CI, 0.73-0.80). For patients receiving dialysis, no such benefits were observed including all-cause mortality (RR, 0.96; CI, 0.88-1.04), cardiovascular mortality (RR, 0.94; CI, 0.82-1.07), or cardiovascular events (RR, 0.95; CI, 0.87-1.03). Effects of statins in kidney transplant recipients were uncertain. Statins had little or no effect on cancer, myalgia, liver function, or withdrawal from treatment, although adverse events were evaluated systematically in fewer than one-half of the trials.

Conclusions:

The authors concluded that statins decrease mortality and cardiovascular events in patients with chronic kidney disease at early stages, but do not appear beneficial among patients with later stage disease (i.e., those on dialysis).

Perspective:

This review and meta-analysis suggests that time of statin therapy is important among patients with chronic renal impairment, and suggests the need for further research as to why patients on hemodialysis would not benefit from statins, as they are at increased risk for cardiovascular disease events.

Clinical Topics: Dyslipidemia, Nonstatins, Novel Agents, Statins

Keywords: Uncertainty, Renal Dialysis, Risk, Kidney Transplantation, Neoplasms, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cardiovascular Diseases, Confidence Intervals, Renal Insufficiency, Chronic, Myalgia


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