C M Messow1, C Isles2. 1. Robertson Centre for Biostatistics, University of Glasgow, Glasgow G12 8QQ, UK. 2. Medical Unit, Dumfries and Galloway Royal Infirmary, Dumfries DG1 4AP, UK.
Abstract
BACKGROUND: Attempts to reduce the burden of vascular disease in advanced chronic kidney disease (CKD) by control of lipids have not been as successful as predicted. AIM: To determine the extent to which the effectiveness of statins varies by kidney class. DESIGN: Meta-analysis. METHODS: We selected randomized trials of statin vs. placebo that gave outcomes for CKD3 (eGFR 30-59 ml/min), CKD4 (eGFR 15-29 ml/min), CKD5 (eGFR < 15 ml/min)/5D(dialysis) and transplant patients separately. Data sources were the Cholesterol Triallists' Treatment Collaboration and previously published meta-analyses. Main outcome measures were major cardiovascular events (MACE), cardiovascular death and all-cause mortality (ACM). RESULTS: A total of 13 studies provided 19 386 participants with CKD3, 2565 with CKD4, 7051 with CKD5/5D and 2102 with a functioning renal transplant. Statins reduced MACE (pooled HR 0.72, 95% CI 0.67-0.78) and ACM (0.82, 0.73-0.91) in CKD3; probably reduced MACE (0.78, 0.62-0.99) in CKD4; and probably reduced cardiovascular death (0.62, 0.40-0.96) in renal transplants. There were no cardiovascular or ACM data in CKD4; there was no convincing evidence of benefit for any outcome in CKD5/5D; and no significant reduction in MACE or ACM in patients with a functioning transplant. CONCLUSIONS: Statins are indicated in CKD3, probably indicated in CKD4, not indicated in CKD5/5D and probably indicated in patients with a functioning transplant. Too few patients with CKD4 and renal transplants have been included in lipid lowering trials for confident conclusions to be drawn.
BACKGROUND: Attempts to reduce the burden of vascular disease in advanced chronic kidney disease (CKD) by control of lipids have not been as successful as predicted. AIM: To determine the extent to which the effectiveness of statins varies by kidney class. DESIGN: Meta-analysis. METHODS: We selected randomized trials of statin vs. placebo that gave outcomes for CKD3 (eGFR 30-59 ml/min), CKD4 (eGFR 15-29 ml/min), CKD5 (eGFR < 15 ml/min)/5D(dialysis) and transplant patients separately. Data sources were the Cholesterol Triallists' Treatment Collaboration and previously published meta-analyses. Main outcome measures were major cardiovascular events (MACE), cardiovascular death and all-cause mortality (ACM). RESULTS: A total of 13 studies provided 19 386 participants with CKD3, 2565 with CKD4, 7051 with CKD5/5D and 2102 with a functioning renal transplant. Statins reduced MACE (pooled HR 0.72, 95% CI 0.67-0.78) and ACM (0.82, 0.73-0.91) in CKD3; probably reduced MACE (0.78, 0.62-0.99) in CKD4; and probably reduced cardiovascular death (0.62, 0.40-0.96) in renal transplants. There were no cardiovascular or ACM data in CKD4; there was no convincing evidence of benefit for any outcome in CKD5/5D; and no significant reduction in MACE or ACM in patients with a functioning transplant. CONCLUSIONS: Statins are indicated in CKD3, probably indicated in CKD4, not indicated in CKD5/5D and probably indicated in patients with a functioning transplant. Too few patients with CKD4 and renal transplants have been included in lipid lowering trials for confident conclusions to be drawn.
Authors: Archna Bajaj; Scott M Damrauer; Amanda H Anderson; Dawei Xie; Matthew J Budoff; Alan S Go; Jiang He; James P Lash; Akinlolu Ojo; Wendy S Post; Mahboob Rahman; Muredach P Reilly; Danish Saleheen; Raymond R Townsend; Jinbo Chen; Daniel J Rader Journal: Arterioscler Thromb Vasc Biol Date: 2017-08-24 Impact factor: 8.311
Authors: Archna Bajaj; Dawei Xie; Esteban Cedillo-Couvert; Jeanne Charleston; Jing Chen; Rajat Deo; Harold I Feldman; Alan S Go; Jiang He; Edward Horwitz; Radhakrishna Kallem; Mahboob Rahman; Matthew R Weir; Amanda H Anderson; Daniel J Rader Journal: Am J Kidney Dis Date: 2019-01-25 Impact factor: 8.860
Authors: Jong Yeob Kim; Johanna Steingroever; Keum Hwa Lee; Jun Oh; Min Jae Choi; Jiwon Lee; Nicholas G Larkins; Franz Schaefer; Sung Hwi Hong; Gwang Hun Jeong; Jae Il Shin; Andreas Kronbichler Journal: J Clin Med Date: 2020-02-01 Impact factor: 4.241