Log in to MyACC
Continuation of Statins Into Dialysis Therapy Period and Mortality
Study Questions:
Does continuation of statins in patients with advanced chronic kidney disease into the dialysis therapy period improve survival?
Methods:
The authors conducted a retrospective cohort study of US veterans transitioning to dialysis between October 1, 2007, and March 30, 2014. Participants were 14,298 US veterans who were receiving statins during the 12-month period before transition to dialysis and survived the first year of dialysis. Statin continuation (n = 11,936) was defined as ≥6 months during the first year after dialysis initiation and statin discontinuation (n = 2,362) if statins were stopped or no statin therapy was received in the year post-transition. Associations of statin continuation with 12-month all-cause mortality and cardiovascular (CV) mortality after 1 year of dialysis initiation were examined using Cox proportional hazards regression models adjusted for demographics and comorbidities.
Results:
Mean age was 71 (10) years; 96.7% male and 21.3% (n = 3,043) African American, and 74.6% (n = 10,627) had diabetes. The 12-month all-cause mortality and CV mortality rates after 1 year of transition to dialysis were lower in statin continuers: deaths per 100 person-years were 21.9 (95% confidence interval [CI], 20.9-22.8) and 8.1 (95% CI, 7.5-8.6) in statin continuers versus 30.3 (95% CI, 27.8-32.8) and 9.8 (95% CI, 8.3-11.2) in statin discontinuers. Moreover, lower all-cause mortality and CV mortality risks with statin continuation persisted in adjusted analyses, with hazard ratios of 0.72 and 0.82, respectively. Associations were similar across subgroups, including age, race, smokers, low-density lipoprotein cholesterol <70 mg/dl, and diabetes status.
Conclusions:
The continuation of statin therapy after transition to dialysis was associated with reduced all-cause mortality and CV mortality. The study findings suggest that future studies are needed to examine potential CV benefits of continuing statin therapy after dialysis initiation.
Perspective:
The guidelines already support continuation of statins when transitioning to dialysis. It will be hard to design a study considering the results, particularly with the endpoint being within 1 year.
Keywords: Cholesterol, LDL, Diabetes Mellitus, Geriatrics, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Kidney Failure, Chronic, Primary Prevention, Renal Dialysis, Renal Insufficiency, Chronic, Risk, Smoking
< Back to Listings
