CONTEXT: Patients with chronic kidney disease are at high risk for sepsis and sepsis-related mortality. OBJECTIVE: To assess whether statin use is associated with a reduction in sepsis events [corrected] in dialysis patients. DESIGN, SETTING, AND PATIENTS: National prospective cohort study that enrolled 1041 incident dialysis patients at 81 US not-for-profit outpatient dialysis clinics from October 1995 to June 1998, with follow-up to January 2005. Statin use was determined by medical record review. Rates of sepsis events [corrected] between statin users and control patients were compared using multivariate regression models, with adjustment for potential confounders in the overall cohort and in a subcohort in which control patients were matched to statin users according to their likelihood (propensity) to have been prescribed a statin. MAIN OUTCOME MEASURE: Sepsis events [corrected] were determined through hospital records from the United States Renal Data System (mean follow-up, 3.4 years). RESULTS: There were 303 sepsis events [corrected] Rates of sepsis events [corrected] were significantly lower in patients receiving statins (crude incidence rate, 41/1000 patient-years) than in those not receiving statins (crude incidence rate, 110/1000 patient-years) (P<.001). With adjustment for demographics and dialysis modality, statin users were substantially less likely to be subsequently hospitalized for sepsis (incidence rate ratio, 0.41; 95% confidence interval [CI], 0.25-0.68). Further adjustment for comorbidities and laboratory values continued to show this protective association (incidence rate ratio, 0.38; 95% CI, 0.21-0.67). In the propensity-matched subcohort, statin use was even more protective (incidence rate ratio, 0.24; 95% CI, 0.11-0.49). CONCLUSIONS: Use of statins was strongly and independently associated with a reduction in the risk of sepsis events [corrected] in patients who had chronic kidney disease and were receiving dialysis. Randomized trials of statins in patients with chronic kidney disease should examine the prevention of sepsis as a potentially important benefit.
CONTEXT: Patients with chronic kidney disease are at high risk for sepsis and sepsis-related mortality. OBJECTIVE: To assess whether statin use is associated with a reduction in sepsis events [corrected] in dialysis patients. DESIGN, SETTING, AND PATIENTS: National prospective cohort study that enrolled 1041 incident dialysis patients at 81 US not-for-profit outpatient dialysis clinics from October 1995 to June 1998, with follow-up to January 2005. Statin use was determined by medical record review. Rates of sepsis events [corrected] between statin users and control patients were compared using multivariate regression models, with adjustment for potential confounders in the overall cohort and in a subcohort in which control patients were matched to statin users according to their likelihood (propensity) to have been prescribed a statin. MAIN OUTCOME MEASURE: Sepsis events [corrected] were determined through hospital records from the United States Renal Data System (mean follow-up, 3.4 years). RESULTS: There were 303 sepsis events [corrected] Rates of sepsis events [corrected] were significantly lower in patients receiving statins (crude incidence rate, 41/1000 patient-years) than in those not receiving statins (crude incidence rate, 110/1000 patient-years) (P<.001). With adjustment for demographics and dialysis modality, statin users were substantially less likely to be subsequently hospitalized for sepsis (incidence rate ratio, 0.41; 95% confidence interval [CI], 0.25-0.68). Further adjustment for comorbidities and laboratory values continued to show this protective association (incidence rate ratio, 0.38; 95% CI, 0.21-0.67). In the propensity-matched subcohort, statin use was even more protective (incidence rate ratio, 0.24; 95% CI, 0.11-0.49). CONCLUSIONS: Use of statins was strongly and independently associated with a reduction in the risk of sepsis events [corrected] in patients who had chronic kidney disease and were receiving dialysis. Randomized trials of statins in patients with chronic kidney disease should examine the prevention of sepsis as a potentially important benefit.
Authors: Sachin Yende; Karina Alvarez; Laura Loehr; Aaron R Folsom; Anne B Newman; Lisa A Weissfeld; Richard G Wunderink; Stephen B Kritchevsky; Kenneth J Mukamal; Stephanie J London; Tamara B Harris; Doug C Bauer; Derek C Angus Journal: Chest Date: 2013-09 Impact factor: 9.410
Authors: Laura C Plantinga; Nancy E Fink; Michal L Melamed; William A Briggs; Neil R Powe; Bernard G Jaar Journal: Clin J Am Soc Nephrol Date: 2008-06-18 Impact factor: 8.237
Authors: John P Magulick; Christopher R Frei; Sayed K Ali; Eric M Mortensen; Mary Jo Pugh; Christine U Oramasionwu; Kelly R Daniels; Ishak A Mansi Journal: Am J Med Sci Date: 2014-03 Impact factor: 2.378
Authors: Kelly Lima Calisto; Bruno de Melo Carvalho; Eduardo Rochete Ropelle; Francine Cappa Mittestainer; Angélica Costa Aranha Camacho; Dioze Guadagnini; José Barreto Campelo Carvalheira; Mario José Abdalla Saad Journal: PLoS One Date: 2010-12-06 Impact factor: 3.240