Effect of Statins on Renal Function in Chronic Kidney Disease Patients

Hu, Ping; Wu, Mei Yi; Lin, Tsu Chen; Chen, Tzu Ting; Wu, Yungang; Su, Sui-Lung; Lu, Kuo Cheng; Chen, Jin Shuen; Sung, Fung Chang; Lee, Chien Te; Yang, Yu; Hwang, Shang Jyh; Wang, Ming Cheng; Hsu, Yung Ho; Chiou, Hung Yi; Wong, Chu‐Kwan; Lin, Yuh Feng

doi:10.1038/s41598-018-34632-z

Cited by 23 publications

(18 citation statements)

References 28 publications

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“…The results of these studies, as well as ours, indicated the paradoxical phenomenon that low LDL-C levels are correlated to poor prognosis. The Findings from a study conducted by Hu et al enrolling 3441 patients with CKD showed that no significant benefit was seen from statins in kidney function deterioration for patients with CKD [ 26 ]. While, for patients with baseline eGFR < 45 mL/min/1.73 m2 (CKD stage 3B-5), the effect of statins was significant.…”

Section: Discussionmentioning

confidence: 99%

Association between baseline LDL-C and prognosis among patients with coronary artery disease and advanced kidney disease

et al. 2021

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Background Lower low-density lipoprotein cholesterol (LDL-C) is significantly associated with improved prognosis in patients with coronary artery disease (CAD). However, LDL-C reduction does not decrease all-cause mortality among CAD patients when renal function impairs. The association between low baseline LDL-C (< 1.8 mmol/L) and mortality is unknown among patients with CAD and advanced kidney disease (AKD). The current study aimed to evaluate prognostic value of low baseline LDL-C level for all-cause death in these patients. Methods In this observational study, 803 CAD patients complicated with AKD (eGFR < 30 mL/min/1.73 m2) were enrolled between January 2008 to December 2018. Patients were divided into two groups (LDL-C < 1.8 mmol/L, n = 138; LDL-C ≥ 1.8 mmol/L, n = 665). We used Kaplan-Meier methods and Cox regression analyses to assess the association between baseline low LDL-C levels and long-term all-cause mortality. Results Among 803 participants (mean age 67.4 years; 68.5% male), there were 315 incidents of all-cause death during a median follow-up of 2.7 years. Kaplan–Meier analysis showed that low LDL-C levels were associated with worse prognosis. After adjusting for full 24 confounders (e.g., age, diabetes, heart failure, and dialysis, etc.), multivariate Cox regression analysis revealed that lower LDL-C level (< 1.8 mmol/L) was significantly associated with higher risk of all-cause death (adjusted HR, 1.38; 95% CI, 1.01–1.89). Conclusions Our data demonstrated that among patients with CAD and AKD, a lower baseline LDL-C level (< 1.8 mmol/L) did not present a higher survival rate but was related to a worse prognosis, suggesting a cautiousness of too low LDL-C levels among patients with CAD and AKD.

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Section: Discussionmentioning

confidence: 99%

Association between baseline LDL-C and prognosis among patients with coronary artery disease and advanced kidney disease

et al. 2021

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“…Lipoprotein abnormalities have been identified as possible causes of kidney damage, especially glomerular injury [21]. Dyslipidemia is associated with nephropathy and has been shown to play a key role in the development and progression of kidney disease.…”

Section: Discussionmentioning

confidence: 99%

Plasma triglyceride levels and central obesity predict the development of kidney injury in Chinese community older adults

Cao

Sun²,

et al. 2019

Renal Failure

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Objective: Despite the achievement of blood glucose, blood pressure targets, the risk for kidney injury remains high among older adults. This observational retrospective study investigated whether high TG or high WC contribute to this high residual risk for kidney injury. Methods: A total of 843 elderly from Dongli Community, Tianjin, China, we selected 666 individuals with a baseline estimated glomerular filtration rate (eGFR) 60 mL/min/1.73 m 2 and negative microalbuminuria completing a 3-year follow-up. At baseline, subjects were grouped according to the levels of TG and WC. The primary outcome was the incidence of kidney injury, defined as low eGFR (eGFR <60 mL/min/1.73 m 2) or reduced eGFR (eGFR reduced >25%) or UACR 30 mg/g. Results: Overall, 6.01% developed low eGFR, 11.11% reduced eGFR, 25.98% UACR 30 mg/g, and 3.45% low eGFR and UACR 30mg/g after 3-year follow-up. TG 1.7 mmol/L increased the risk of eGFR <60 mL/min/1.73 m 2 by 1.44-fold, of UACR 30 mg/g by 32%, and of developing both abnormality by 1.41-fold in model 1; further adjustment for potential confounders factors, the association is slightly weakened in model 2 and 3; WC (90 cm in men and 85 cm in women) were associated with a 1.68-fold higher risk of eGFR <60 mL/min/1.73 m 2 and a 1.43fold risk of UACR 30 mg/g and a 1.89-fold risk of developing both abnormality in model 1. Further adjustment for potential confounders factors, the association is slightly weakened in model 2 and 3. Conclusions: In a population of Chinese community-dwelling older adults, high TG and central obesity were risk factors for the development of kidney injury over 3 years.

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“…Conversely, the double-blind SHARP study (Study of Heart and Renal Protection) on over nine thousand patients with CKD found that simvastatin in combination with ezetimibe (inhibitor of cholesterol intestinal absorption) reduced total cholesterol, LDL and the incidence of major atherosclerotic events, but no benefit to the kidney function was observed [133]. Finally, a recent retrospective cohort study by Hu et al showed that patients with CKD stage 3B-5 taking statins have a significantly lower proteinuria as compared with those patients who were not taking statins (Odds Ratio: 0.68, 95% CI 0.48–0.95) [134]. A summary of the most relevant studies on lipid-lowering drugs for the treatment of CKD is reported in Table 1.…”

Section: Treatmentmentioning

confidence: 99%

Lipid Accumulation and Chronic Kidney Disease

et al. 2019

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Obesity and hyperlipidemia are the most prevalent independent risk factors of chronic kidney disease (CKD), suggesting that lipid accumulation in the renal parenchyma is detrimental to renal function. Non-esterified fatty acids (also known as free fatty acids, FFA) are especially harmful to the kidneys. A concerted, increased FFA uptake due to high fat diets, overexpression of fatty acid uptake systems such as the CD36 scavenger receptor and the fatty acid transport proteins, and a reduced β-oxidation rate underlie the intracellular lipid accumulation in non-adipose tissues. FFAs in excess can damage podocytes, proximal tubular epithelial cells and the tubulointerstitial tissue through various mechanisms, in particular by boosting the production of reactive oxygen species (ROS) and lipid peroxidation, promoting mitochondrial damage and tissue inflammation, which result in glomerular and tubular lesions. Not all lipids are bad for the kidneys: polyunsaturated fatty acids (PUFA) such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) seem to help lag the progression of chronic kidney disease (CKD). Lifestyle interventions, especially dietary adjustments, and lipid-lowering drugs can contribute to improve the clinical outcome of patients with CKD.

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Effect of Statins on Renal Function in Chronic Kidney Disease Patients

Cited by 23 publications

References 28 publications

Association between baseline LDL-C and prognosis among patients with coronary artery disease and advanced kidney disease

Association between baseline LDL-C and prognosis among patients with coronary artery disease and advanced kidney disease

Plasma triglyceride levels and central obesity predict the development of kidney injury in Chinese community older adults

Lipid Accumulation and Chronic Kidney Disease

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