G. V. Ramesh Prasad, MBBS, FRCPC
What is the efficacy of lipid-lowering therapy for clinical outcomes in chronic kidney disease (CKD)?
Included studies compared ≥ 1 lipid-lowering agent (statins, ezetimibe, niacin, colestipol, or cholestyramine) with placebo, no treatment, or other lipid-lowering treatment in patients with CKD; had ≥ 6 months of follow-up; and included ≥ 100 adults or ≥ 25 children with CKD in each treatment group. Trials of dietary supplements, phosphate binders, apheresis, stanols, or sterols were excluded. Outcomes included all-cause, cardiovascular (CV), and cardiac mortality; and a composite of CV events.
MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (2000 to Nov 2011); a 2003 systematic review*; and reference lists were searched for peer-reviewed, randomized, controlled trials (RCTs) and systematic reviews. 18 RCTs met inclusion criteria: 5 were done in patients with CKD (n = 15 603, mean age range 50 to 66 y, 54% to 69% men) and 13 in the general population with subgroup analyses reported in patients with CKD (n = 20 926 with CKD, mean age range 52 to 70 y, 35% to 82% men). All RCTs were done in adults. 16 RCTs evaluated statins, and 2 evaluated simvastatin plus ezetimibe. 13 trials compared lipid-lowering therapy with placebo, 2 with usual care, 2 with another statin or statin dose, and 1 with diet modification. Subgroup analyses by dialysis status were preplanned.
Meta-analysis in all CKD patients showed that lipid-lowering therapy decreased all-cause and cardiac mortality and CV events, including revascularization, more than control treatment; groups did not differ for CV mortality (Table). In CKD patients not receiving maintenance dialysis, lipid-lowering therapy decreased all-cause and cardiac mortality and CV events (Table); in those having dialysis, lipid-lowering therapy decreased cardiac mortality (Table).
Lipid-lowering drugs decrease all-cause and cardiac mortality and cardiovascular events more than control treatment in adults with chronic kidney disease.
Lipid-lowering drugs vs control treatment in adults with CKD†
†CKD = chronic kidney disease; CV = cardiovascular; NR = not reported; NS = not significant; other abbreviations defined in Glossary. Weighted event rates, RRR, NNT, and CI calculated from risk ratios and either raw control event rates (CV mortality) or pooled control rate estimates per 1000 (all-cause mortality, cardiac mortality, and CV events) reported in article using a random-effects model.
‡Strength of evidence for all patients was moderate (all-cause mortality and CV events) or high (CV and cardiac mortality) using modified Grading of Recommendations Assessment, Development, and Evaluation criteria (grades: very low, low, moderate, and high).
§Cardiac or stroke.
||Including revascularization procedures.
Ramesh Prasad GV. Review: Lipid-lowering drugs decrease all-cause and cardiac mortality and CV events in CKD. Ann Intern Med. 2012;157:JC5–5. doi: 10.7326/0003-4819-157-10-201211200-02005
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Published: Ann Intern Med. 2012;157(10):JC5-5.
Cardiology, Chronic Kidney Disease, Coronary Risk Factors, Dyslipidemia, Nephrology.
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