A placebo-controlled trial examining atorvastatin in dyslipidemic patients undergoing CAPD

Harris, Kevin; Wheeler, David C.; Chong, Camilla

doi:10.1046/j.1523-1755.2002.00262.x

Cited by 65 publications

(45 citation statements)

References 17 publications

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“…In contrast, several small short-term trials (29,34) of statins in patients with ESRD have shown that statins were effective in lowering LDL-C levels and could safely be used in this population. Until the publication of the 4D trial, conclusive data regarding the use of lipidlowering therapy were unavailable.…”

Section: Statinsmentioning

confidence: 95%

“…However, the use of these medications was determined at a single point in time, and the study was not powered to examine the association between the use of individual drug classes and mortality. Previous cross-sectional studies (29,30) have demonstrated an association between the use of lipid-lowering agents and lower mortality in dialysis patients. However, this result was not duplicated in a single published randomized controlled trial to date.…”

Section: Mortalitymentioning

confidence: 96%

“…Statins successfully reduce LDL-C levels in patients with CKD, but are infrequently used in CKD (29). Analysis of the United States Renal Data System Dialysis Morbidity and Mortality Study (Wave 2) study data showed that only 9.7% of patients were taking a statin, but that its use was independently associated with a reduced risk of total mortality as well as CVD-specific mortality (30).…”

Section: Statinsmentioning

confidence: 99%

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Cardioprotective medication use in hemodialysis patients

Miller

Hopman

Garland

et al. 2006

Canadian Journal of Cardiology

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C ardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with stage 5 chronic kidney disease (CKD 5), accounting for more than 50% of deaths. After adjusting for age, race, sex and diabetes mellitus, CVD mortality in CKD 5 remains 10 to 20 times higher than in the general population (1). CVD in patients with CKD 5 is multifactorial. In addition to the higher prevalence of traditional cardiac risk factors (2), there is also the contribution of nontraditional cardiac risk factors unique to uremia, including anemia, abnormal calcium-phosphate homeostasis, inflammation, hyperhomocysteinemia, hypervolemia, dialysis dose and modality (3).In the general population, large-scale trials in high-risk individuals have confirmed the value of primary prevention of CVD events with angiotensin-converting enzyme (ACE) inhibition (4), lipid-lowering therapy (5) and acetylsalicylic acid (ASA) (6). These benefits have not been realized in the CKD population, either because many studies have excluded patients with CKD or because these secondary intervention strategies are simply poorly applied in this population. BACKGROUND: Cardiovascular disease is the leading cause of mortality in patients with renal failure, accounting for more than 50% of deaths in end-stage renal disease. Risk factor modification with the use of cardioprotective medications such as angiotensinconverting enzyme inhibitors (ACEIs), beta-adrenergic antagonists (beta-blockers), acetylsalisylic acid (ASA) and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) has been shown to reduce mortality in the general population. OBJECTIVE: To determine the extent of use of these medications in a hemodialysis population. METHODS: This was a cross-sectional study of a cohort of 185 prevalent hemodialysis patients. The inclusion criterion was dialysis dependence and there were no exclusion criteria. Data collection was by chart review. Contraindications to individual medication classes were not obtained. RESULTS: There were 185 patients enrolled, the mean age was 63.42±15.1 years and 126 (68.1%) were male. Sixty-six (35.7%) patients had diabetes and 89 (48.1%) patients had established coronary artery disease (CAD). Forty-six (24.9%) patients were on ACEIs or angiotensin II receptor blockers, 59 (31.9%) were on beta-blockers, 70 (37.8%) were on ASA and 84 (45.4%) were on statins. Although these medications were used in fewer than 60% of patients, those with CAD were more likely to be prescribed an ACEI or an angiotensin II receptor blocker (P=0.026), a beta-blocker (P<0.001), ASA (P<0.001) or a statin (P=0.001) than those without CAD. There were no differences in the use of these medications between diabetic and nondiabetic patients. CONCLUSIONS: Many hemodialysis patients are not prescribed cardioprotective medications. Given the high cardiovascular mortality in this high-risk population, more attention to reducing cardiovascular risk is warranted.

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Section: Statinsmentioning

confidence: 95%

Section: Mortalitymentioning

confidence: 96%

Section: Statinsmentioning

confidence: 99%

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Cardioprotective medication use in hemodialysis patients

Miller

Hopman

Garland

et al. 2006

Canadian Journal of Cardiology

View full text Add to dashboard Cite

show abstract

“…With regard to statin-related adverse effects, studies in CRF (29), in dialysis patients (57) and in renal transplant recipients (40), all are suggestive of good side-effect profiles. However, accurate estimates of the risk of adverse events (especially myopathy) are not available in patients with ESRD or moderate to severe CRI, because the existing clinical trials with statins in these patients have been small.…”

Section: Conclusion and Future Trialsmentioning

confidence: 99%

“…However, accurate estimates of the risk of adverse events (especially myopathy) are not available in patients with ESRD or moderate to severe CRI, because the existing clinical trials with statins in these patients have been small. A study by Tonelli et al (29) excluded subjects with moderate to severe CRI or with more than mild proteinuria, whereas Harris et al (57) had Ͻ90 patients on a statin.…”

Section: Conclusion and Future Trialsmentioning

confidence: 99%