G. V. Ramesh Prasad, MBBS, FRCPC
What is the efficacy of statin therapy in adults with chronic kidney disease (CKD)? Do effects differ by CKD stage?
Included studies compared statin therapy with placebo or no treatment in adults with CKD and had ≥ 8 weeks of follow-up. Outcomes included all-cause and cardiovascular (CV) mortality and major CV events as defined in individual studies.
EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials, and Cochrane Renal Group Specialised Register to Feb 2012; and a 2008 systematic review* were searched for randomized controlled trials (RCTs). 80 RCTs (86 comparisons, n = 51 099, mean age range 23 to 73 y, 24% to 89% men, follow-up range 2 mo to 5.5 y) met inclusion criteria: 48 comparisons were done in patients not having dialysis (n = 39 820), 21 in those having dialysis (n = 7982), and 17 in kidney transplant recipients (n = 3297). Subgroup analyses by dialysis and kidney transplant status were preplanned. 15 RCTs had adequate allocation concealment, 36 used blinding in patients or investigators and 17 in outcome assessors, 18 used intention-to-treat analysis, and 19 had adequate follow-up. Results of 9 RCTs that compared statin therapy with the same or other statins are not reported in this abstract.
Meta-analysis showed that statin therapy reduced all-cause and CV mortality and major CV events more than placebo or no treatment (Table). In subgroup analyses, statins reduced all outcomes in patients not receiving dialysis at study entry but not in those receiving dialysis or with a history of kidney transplant at study entry (all-cause mortality, Pinteraction = 0.009; CV mortality, Pinteraction = 0.08; CV events, Pinteraction < 0.001) (Table).
Statin therapy decreases all-cause mortality and major cardiovascular events in adults with chronic kidney disease who are not receiving dialysis.
Statin therapy vs placebo or no treatment in adults with CKD†
†CKD = chronic kidney disease; CV = cardiovascular; NS = not significant; other abbreviations defined in Glossary. Weighted event rates, RRR, RRI, NNT, and CI calculated from risk ratios and control event rates in article using a random-effects model.
‡Grading of Recommendations Assessment, Development, and Evaluation criteria (grades: very low, low, moderate, and high).
§Interactions for treatment by CKD status (nondialysis, dialysis, or kidney transplantation): all-cause mortality, P = 0.009; CV mortality, P = 0.08; major CV events, P < 0.001.
||Revised control event rate (477/2312) provided by author.
G. V. Ramesh Prasad. Review: Statins decrease mortality and major CV events in adults with CKD not receiving dialysis. Ann Intern Med. 2012;157:JC5–4. doi: 10.7326/0003-4819-157-10-201211200-02004
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Published: Ann Intern Med. 2012;157(10):JC5-4.
Cardiology, Chronic Kidney Disease, Coronary Risk Factors, Nephrology, Renal Replacement Therapy.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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