Ashish Upadhyay, MD; Amy Earley, BS; Jenny L. Lamont, MS; Shana Haynes, DHSc, MS; Christoph Wanner, MD; Ethan M. Balk, MD, MPH
Grant Support: Dr. Upadhyay, Ms. Earley, Ms. Lamont, Dr. Haynes, and Dr. Balk were supported by KDIGO.
Potential Conflicts of Interest: Dr. Upadhyay: Grant (money to institution): National Kidney Foundation. Ms. Earley: Grant (money to institution): National Kidney Foundation. Ms. Lamont: Grant (money to institution): National Kidney Foundation. Dr. Haynes: Grant (money to institution): National Kidney Foundation. Dr. Wanner: Support for travel to meetings for the study or other purposes: National Kidney Foundation; Board membership: Boehringer Ingelheim; Grants/grants pending (money to institution): Genzyme; Payment for lectures including service on speakers bureaus: Genzyme, Abbott, Amgen. Dr. Balk: Grant (money to institution): KDIGO, National Kidney Foundation. Disclosures can be also viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2984.
Requests for Single Reprints: Ashish Upadhyay, MD, Renal Section, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 72 East Concord Street, Evans 124, Boston, MA 02118; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Upadhyay: Renal Section, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 72 East Concord Street, Evans 124, Boston, MA 02118.
Ms. Earley, Ms. Lamont, and Dr. Balk: Center for Clinical Evidence Synthesis, Tufts University School of Medicine, 800 Washington Street, Box 63, Boston, MA 02111.
Dr. Haynes: Division of Nephrology, Tufts Medical Center, 800 Washington Street, Box 391, Boston, MA 02111.
Dr. Wanner: Division of Nephrology, University of Würzburg, Oberduerrbacherstr 6, 97080 Würzburg, Germany.
Author Contributions: Conception and design: A. Upadhyay, A. Earley, S. Haynes, C. Wanner, E.M. Balk.
Analysis and interpretation of the data: A. Upadhyay, A. Earley, S. Haynes, C. Wanner, E.M. Balk.
Drafting of the article: A. Upadhyay, A. Earley, J.L. Lamont, C. Wanner, E.M. Balk.
Critical revision of the article for important intellectual content: A. Upadhyay, A. Earley, S. Haynes, C. Wanner, E.M. Balk.
Final approval of the article: A. Upadhyay, A. Earley, J.L. Lamont, S. Haynes, C. Wanner, E.M. Balk.
Statistical expertise: E.M. Balk.
Administrative, technical, or logistic support: A. Upadhyay, J.L. Lamont.
Collection and assembly of data: A. Upadhyay, A. Earley, J.L. Lamont, S. Haynes.
Upadhyay A, Earley A, Lamont JL, Haynes S, Wanner C, Balk EM. Lipid-Lowering Therapy in Persons With Chronic Kidney Disease: A Systematic Review and Meta-analysis. Ann Intern Med. 2012;157:251-262. doi: 10.7326/0003-4819-157-4-201208210-00005
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Published: Ann Intern Med. 2012;157(4):251-262.
Lipid-lowering therapy is not widely used in persons with chronic kidney disease (CKD) despite a high burden of dyslipidemia and cardiovascular disease in this population.
To synthesize evidence examining the effect of lipid-lowering therapy on clinical outcomes in persons with CKD.
MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from January 2000 through November 2011.
Randomized, controlled trials (RCTs) comparing lipid-lowering therapy with control treatment in persons with CKD, including subgroup analyses of trials in the general population.
Abstracts were screened and data were extracted on study methodology, population, interventions, cardiovascular and kidney outcomes, and adverse events. Data were extracted by one author and confirmed by another. Study quality was determined by consensus. Random-effects model meta-analyses were performed.
18 RCTs, all in adults, met the eligibility criteria. Five RCTs involved CKD populations, and 13 were CKD subgroup analyses from trials in the general population. Sixteen RCTs examined statins, and 2 examined statins plus ezetimibe. Lipid-lowering therapy does not improve kidney outcomes but decreases the risk for cardiac mortality (pooled risk ratio [RR] from 6 trials, 0.82 [95% CI, 0.74 to 0.91]; P < 0.001), cardiovascular events (including revascularization) (pooled RR from 9 trials, 0.78 [CI, 0.71 to 0.86]; P < 0.001), and myocardial infarction (pooled RR from 9 trials, 0.74 [CI, 0.67 to 0.81]; P < 0.001). Significant benefit was also seen for all-cause mortality but was limited by a high degree of heterogeneity. No benefit was found for other cardiovascular outcomes. Rates of adverse events were similar between intervention and comparator groups.
Lack of data in children, heterogeneity among reviewed studies, and the possibility of selective reporting of outcomes and adverse events.
Lipid-lowering therapy decreases cardiac death and atherosclerosis-mediated cardiovascular events in persons with CKD.
Kidney Diseases: Improving Global Outcomes.
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Cardiology, Nephrology, Dyslipidemia, Chronic Kidney Disease, Coronary Risk Factors.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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