Beneficial effects of fluvastatin on progressive renal allograft dysfunction

Konstadinidou, I; Boletis, John; Περρέα, Δέσποινα; Triantafyllou, Aggeliki; Filiopoulos, V.; Stamataki, E.; Kostakis, A.; Stathakis, C

doi:10.1016/s0041-1345(03)00376-2

Cited by 9 publications

(4 citation statements)

References 20 publications

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“…Indirect evidence has indicated the beneficial effects of statins on vessel stiffening and endothelial function in patients with CKD [ 14 , 15 ]. After renal injury, dyslipidemia may accelerate and perpetuate the yearly decline in the glomerular filtration rate (GFR) [ 16 – 18 ]; however, this effect has been confirmed through post hoc analyses, which can be limited by unmeasured confounders closely correlated with dyslipidemia [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Statins and Renin Angiotensin System Inhibitors Dose-Dependently Protect Hypertensive Patients against Dialysis Risk

Liu

Hsu

2016

PLoS ONE

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BackgroundTaiwan has the highest renal disease incidence and prevalence in the world. We evaluated the association of statin and renin–angiotensin system inhibitor (RASI) use with dialysis risk in hypertensive patients.MethodsOf 248,797 patients who received a hypertension diagnosis in Taiwan during 2001–2012, our cohort contained 110,829 hypertensive patients: 44,764 who used RASIs alone; 7,606 who used statins alone; 27,836 who used both RASIs and statins; and 33,716 who used neither RASIs or statins. We adjusted for the following factors to reduce selection bias by using propensity scores (PSs): age; sex; comorbidities; urbanization level; monthly income; and use of nonstatin lipid-lowering drugs, metformin, aspirin, antihypertensives, diuretics, and beta and calcium channel blockers. The statin and RASI use index dates were considered the hypertension confirmation dates. To examine the dose–response relationship, we categorized only statin or RASI use into four groups in each cohort: <28 (nonusers), 28–90, 91–365, and >365 cumulative defined daily doses (cDDDs).ResultsIn the main model, PS-adjusted hazard ratios (aHRs; 95% confidence intervals [CIs]) for dialysis risk were 0.57 (0.50–0.65), 0.72 (0.53–0.98), and 0.47 (0.41–0.54) in the only RASI, only statin, and RASI + statin users, respectively. RASIs dose-dependently reduced dialysis risk in most subgroups and in the main model. RASI use significantly reduced dialysis risk in most subgroups, regardless of comorbidities or other drug use (P < 0.001). Statins at >365 cDDDs protected hypertensive patients against dialysis risk in the main model (aHR = 0.62, 95% CI: 0.54–0.71), regardless of whether a high cDDD of RASIs, metformin, or aspirin was used.ConclusionStatins and RASIs independently have a significant dose-dependent protective effect against dialysis risk in hypertensive patients. The combination of statins and RASIs can additively protect hypertensive patients against dialysis risk.

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Section: Introductionmentioning

confidence: 99%

Statins and Renin Angiotensin System Inhibitors Dose-Dependently Protect Hypertensive Patients against Dialysis Risk

Liu

Hsu

2016

PLoS ONE

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“…Typically, these studies utilised a fluvastatin dosage of 20-40 mg daily [21]. TC concentration decreased on average by 20%, LDL-C concentration by 30%, while most of the studies showed a significant effect on TG and HDL-C levels as well [114,[137][138][139][140][141][142][143][144][145]. However, the results of a recent study showed a decrease by only 5% in LDL-C levels six months after the initiation of fluvastatin 20 mg daily [146].…”

Section: E Fluvastatinmentioning

confidence: 99%

Statins and Solid Organ Transplantation

Gazi¹,

Liberopoulos²,

Athyros³

et al. 2006

CPD

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Dyslipidaemia is common in solid organ transplant recipients and its presence is associated with chronic rejection and accelerated atherosclerosis, leading to an increased prevalence of cardiovascular disease (CVD). CVD is a major cause of morbidity and mortality in transplant recipients. It is therefore of interest and clinical value to introduce agents that effectively and safely reduce the incidence of this outcome. In the present review we consider the potential benefits of statin administration in adults who have undergone solid organ (mainly renal, heart and liver) transplantation, as well as in paediatric transplant patients. We also briefly review the effects of combination therapy with ezetimibe and statins in this population. Overall, statins are efficient and safe drugs for the management of dyslipidaemias in transplant populations, and in most trials they had a beneficial effect on long-term survival rates, CVD events and rejection rates. The transplanted population is different from other patient groups, mostly due to concomitant immunosuppressive therapy. Statins, at an appropriate dosage, should be prescribed to dyslipidaemic transplanted patients but they should be closely monitored for adverse effects.

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“…Um recente estudo com a fluvastatina demonstrou redução no declínio da função do enxerto renal 25 . Em contrate, o ALERT 26 não demonstrou benefício da fluvastatina na redução da progressão da disfunção renal em pacientes transplantados renais.…”

Section: Efeitos Das Estatinas Sobre a Função Renalunclassified

Estatinas na doença renal crônica

Ferreira

Rocha

Saraiva

2005

Arq. Bras. Cardiol.

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INTRODUÇÃOAnormalidades no metabolismo lipídico são comuns em pacientes com doença renal crônica (DRC) em tratamento conservador, em diálise ou após o transplante renal. Estes pacientes apresentam um perfil lipídico tipicamente trombogênico, com predomínio de elevação dos níveis de triglicérides (TG) e redução do HDL-colesterol (HDL-c). A elevação dos TG é explicada pela redução da sua remoção devido à redução da atividade da lipase lipoprotéica e da lipase triglicerídea hepática. Os níveis do colesterol total (CT) podem ser normais, talvez em parte devido à presença da desnutrição. Estas alterações podem ser observadas em fases iniciais do declínio da função renal (taxa de filtração glomerular < 60 ml/min). Os níveis de VLDL e IDLcolesterol, mas não necessariamente de LDL-c, estão elevados. A composição do LDL é anormal, apresentando aumento no seu conteúdo de TG. Ocorre um acúmulo dos remanescentes de lipoproteínas no plasma dos pacientes com DRC, que são partículas altamente aterogênicas 1,2 .A mortalidade por doença cardiovascular (DCV) é maior em pacientes com DRC, chegando a ser 10 a 20 vezes superior ao se comparar à população geral, constituindo-se a principal causa de óbito destes pacientes em tratamento conservador, em diálise e após o transplante renal 3 . O risco excessivo da DCV na DRC é explicado em parte pela elevada prevalência dos fatores de risco cardiovasculares Hipertrigliceridemia e o HDL baixo são aspectos comuns em pacientes com insuficiência renal crônica. A mortalidade cardiovascular está substancialmente aumentada na presença de doença renal crônica (10-20 vezes maior). Existem evidências de estudos clínicos com estatinas sugerindo uma ação protetora dessas drogas na progressão da doença renal. Além disso, pacientes pós-transplante renal recebendo fluvastatina, experimentaram redução na incidência de infartos não fatais e de mortalidade cardíaca. Entretanto, um estudo recente com atorvastatina não demonstrou reduções na morbimortalidade cardiovascular entre pacientes diabéticos em hemodiálise. Estudos em andamento definirão o preciso papel das estatinas neste grupo especial de pacientes. PALAVRAS-CHAVE KEY WORDS Statins, end stage renal disease, dyslipidemiaditos "tradicionais" e também pela presença dos fatores de risco "não tradicionais". Estes incluem anormalidades hemodinâmicas e metabólicas decorrentes da disfunção renal como, por exemplo, a anemia, os distúrbios do metabolismo do cálcio e fósforo, a hipervolemia, aumento da lipoproteína (a), hipoalbuminemia, elevação do paratormônio, acidose, hiperhomocisteinemia, desnutrição, inflamação, estresse oxidativo, proteinúria, fatores trombogênicos, atividade do sistema da renina-angiotensina e toxinas urêmicas 4 . Levin et al 5 relatam de forma elegante o paralelismo entre a progressão da doença cardíaca e o declínio da função renal. As duas doenças progridem simultaneamente e têm inúmeros fatores de risco em comum (figura 1), como por exemplo, hipertensão arterial sistêmica (HAS), diabete melito (DM) e dislipidemia. Além disso, exist...

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Beneficial effects of fluvastatin on progressive renal allograft dysfunction

Cited by 9 publications

References 20 publications

Statins and Renin Angiotensin System Inhibitors Dose-Dependently Protect Hypertensive Patients against Dialysis Risk

Statins and Renin Angiotensin System Inhibitors Dose-Dependently Protect Hypertensive Patients against Dialysis Risk

Statins and Solid Organ Transplantation

Estatinas na doença renal crônica

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