BACKGROUND: Statins have uncertain benefits in persons with chronic kidney disease (CKD) because individual trials may have insufficient power to determine whether treatment effects differ with severity of CKD. PURPOSE: To summarize the benefits and harms of statin therapy for adults with CKD and examine whether effects of statins vary by stage of kidney disease. DATA SOURCES: Cochrane and EMBASE databases (inception to February 2012). STUDY SELECTION: Randomized trials comparing the effects of statins with placebo, no treatment, or another statin on mortality and cardiovascular outcomes. DATA EXTRACTION: Two independent reviewers extracted data and assessed risk of bias. DATA SYNTHESIS: Eighty trials comprising 51099 participants compared statin with placebo or no treatment. Treatment effects varied with stage of CKD. Moderate- to high-quality evidence indicated that statins reduced all-cause mortality (relative risk [RR], 0.81 [95% CI, 0.74 to 0.88]), cardiovascular mortality (RR, 0.78 [CI, 0.68 to 0.89]), and cardiovascular events (RR, 0.76 [CI, 0.73 to 0.80]) in persons not receiving dialysis. Moderate- to high-quality evidence indicated that statins had little or no effect on all-cause mortality (RR, 0.96 [CI, 0.88 to 1.04]), cardiovascular mortality (RR, 0.94 [CI, 0.82 to 1.07]), or cardiovascular events (RR, 0.95 [CI, 0.87 to 1.03]) in persons receiving dialysis. Effects of statins in kidney transplant recipients were uncertain. Statins had little or no effect on cancer, myalgia, liver function, or withdrawal from treatment, although adverse events were evaluated systematically in fewer than half of the trials. LIMITATION: There was a reliance on post hoc subgroup data for earlier stages of CKD. CONCLUSION: Statins decrease mortality and cardiovascular events in persons with early stages of CKD, have little or no effect in persons receiving dialysis, and have uncertain effects in kidney transplant recipients.
BACKGROUND: Statins have uncertain benefits in persons with chronic kidney disease (CKD) because individual trials may have insufficient power to determine whether treatment effects differ with severity of CKD. PURPOSE: To summarize the benefits and harms of statin therapy for adults with CKD and examine whether effects of statins vary by stage of kidney disease. DATA SOURCES: Cochrane and EMBASE databases (inception to February 2012). STUDY SELECTION: Randomized trials comparing the effects of statins with placebo, no treatment, or another statin on mortality and cardiovascular outcomes. DATA EXTRACTION: Two independent reviewers extracted data and assessed risk of bias. DATA SYNTHESIS: Eighty trials comprising 51099 participants compared statin with placebo or no treatment. Treatment effects varied with stage of CKD. Moderate- to high-quality evidence indicated that statins reduced all-cause mortality (relative risk [RR], 0.81 [95% CI, 0.74 to 0.88]), cardiovascular mortality (RR, 0.78 [CI, 0.68 to 0.89]), and cardiovascular events (RR, 0.76 [CI, 0.73 to 0.80]) in persons not receiving dialysis. Moderate- to high-quality evidence indicated that statins had little or no effect on all-cause mortality (RR, 0.96 [CI, 0.88 to 1.04]), cardiovascular mortality (RR, 0.94 [CI, 0.82 to 1.07]), or cardiovascular events (RR, 0.95 [CI, 0.87 to 1.03]) in persons receiving dialysis. Effects of statins in kidney transplant recipients were uncertain. Statins had little or no effect on cancer, myalgia, liver function, or withdrawal from treatment, although adverse events were evaluated systematically in fewer than half of the trials. LIMITATION: There was a reliance on post hoc subgroup data for earlier stages of CKD. CONCLUSION: Statins decrease mortality and cardiovascular events in persons with early stages of CKD, have little or no effect in persons receiving dialysis, and have uncertain effects in kidney transplant recipients.
Authors: Sankar D Navaneethan; Sagar U Nigwekar; Vlado Perkovic; David W Johnson; Jonathan C Craig; Giovanni Fm Strippoli Journal: Cochrane Database Syst Rev Date: 2009-04-15
Authors: Paul M Ridker; Eleanor Danielson; Francisco A H Fonseca; Jacques Genest; Antonio M Gotto; John J P Kastelein; Wolfgang Koenig; Peter Libby; Alberto J Lorenzatti; Jean G MacFadyen; Børge G Nordestgaard; James Shepherd; James T Willerson; Robert J Glynn Journal: N Engl J Med Date: 2008-11-09 Impact factor: 91.245
Authors: Michael J Koren; Michael H Davidson; Daniel J Wilson; Rana S Fayyad; Andrea Zuckerman; David P Reed Journal: Am J Kidney Dis Date: 2009-02-11 Impact factor: 8.860
Authors: Dinanda J de Jager; Diana C Grootendorst; Kitty J Jager; Paul C van Dijk; Lonneke M J Tomas; David Ansell; Frederic Collart; Patrik Finne; James G Heaf; Johan De Meester; Jack F M Wetzels; Frits R Rosendaal; Friedo W Dekker Journal: JAMA Date: 2009-10-28 Impact factor: 56.272
Authors: Sankar D Navaneethan; Vlado Perkovic; David W Johnson; Sagar U Nigwekar; Jonathan C Craig; Giovanni F M Strippoli Journal: Cochrane Database Syst Rev Date: 2009-04-15
Authors: Sankar D Navaneethan; Francesca Pansini; Vlado Perkovic; Carlo Manno; Fabio Pellegrini; David W Johnson; Jonathan C Craig; Giovanni F M Strippoli Journal: Cochrane Database Syst Rev Date: 2009-04-15
Authors: Helen M Colhoun; D John Betteridge; Paul N Durrington; Graham A Hitman; H Andrew W Neil; Shona J Livingstone; Valentine Charlton-Menys; David A DeMicco; John H Fuller Journal: Am J Kidney Dis Date: 2009-06-21 Impact factor: 8.860
Authors: Bengt C Fellström; Alan G Jardine; Roland E Schmieder; Hallvard Holdaas; Kym Bannister; Jaap Beutler; Dong-Wan Chae; Alejandro Chevaile; Stuart M Cobbe; Carola Grönhagen-Riska; José J De Lima; Robert Lins; Gert Mayer; Alan W McMahon; Hans-Henrik Parving; Giuseppe Remuzzi; Ola Samuelsson; Sandor Sonkodi; D Sci; Gultekin Süleymanlar; Dimitrios Tsakiris; Vladimir Tesar; Vasil Todorov; Andrzej Wiecek; Rudolf P Wüthrich; Mattis Gottlow; Eva Johnsson; Faiez Zannad Journal: N Engl J Med Date: 2009-03-30 Impact factor: 91.245