Effect of Statins on the Progression of Coronary Calcification in Kidney Transplant Recipients

Abstract

BackgroundCoronary calcification (CAC) is highly prevalent in kidney transplant recipients (KTRs) and has been associated with cardiovascular morbidity and mortality. Some studies have shown a reduction in CAC progression with statin therapy in the general and chronic kidney disease (CKD) populations.Objectives and MethodsThe aim of the present study was to evaluate the effect of statins on CAC progression in incident kidney transplant recipients. Patients were randomly assigned to the statin (n = 61, 10 mg daily) and control group (n = 59). CAC and biochemical analyses were performed at baseline and 12 months.ResultsAt baseline, CAC was observed in 30% and 21% of patients in the statin and control groups, respectively (p = 0.39). The calcium score at baseline and its absolute and relative changes over 12 months of follow up were similar among the groups. In the statin group, total cholesterol (p < 0.001), low density lipoprotein cholesterol (p < 0.001) and triglycerides (p = 0.005) decreased, and the estimated glomerular function rate increased (p<0.001) significantly. CRP levels remained stable (p = 0.52) in the statin group but increased in the control group (p = 0.01). In the multivariate model, there was no difference in CAC progression between the groups (group effect p = 0.034; time-effect p = 0.23; interaction p = 0.74). Similar results were obtained when only patients with ≥ 10AU calcium score (calcified) were analyzed (group effect p = 0.051; time-effect p = 0.58; interaction p = 0.99).ConclusionAlthough statins reduce the levels of cholesterol, triglycerides, inflammation and improve graft function, the dose adopted in the current study did not delay CAC progression within 12 months of follow up.Trial RegistrationBrazilian Clinical Trials Registry RBR-32RFMB

Is progression of coronary artery calcification influenced by modality of renal replacement therapy? A systematic review

“…Of the 29 included studies (32 unique cohorts), most focused on haemodialysis patients [ 10 , 17–35 ] (20 studies, 1499 patients) or kidney transplant recipients [ 30 , 33 , 36–41 ] (8 studies, 649 patients), 2 of which investigated both haemodialysis patients and kidney transplant recipients [ 30 , 33 ]. Three studies (92 patients) investigated peritoneal dialysis patients [ 29 , 42 , 43 ], one of which also investigated haemodialysis patients [ 29 ].…”

“…One study (38 patients) investigated nocturnal haemodialysis patients [ 44 ]. Six studies were randomized controlled trials [ 17 , 22 , 23 , 32 , 35 , 36 ] (five evaluating pharmacological interventions, one evaluating dialysate calcium), two studies were non-randomized controlled trials [ 27 , 34 ] (one of which incorporated a retrospective control group [ 34 ]) and one was a pilot study [ 25 ] (all three evaluating pharmacological interventions). The 20 other studies were observational cohort studies.…”

“…Also, inherent to research in the dialysis setting, attrition rates were substantial in many studies. Frequently subjects that did not complete follow-up were different from subjects that did complete follow-up [ 17 , 24 , 32 , 33 , 36 , 38 , 41 , 42 ] or were not described sufficiently [ 18 , 21 , 23 , 25–30 , 34 , 36–40 , 43 ]. In three publications, renal replacement therapy was described as ‘dialysis, not otherwise specified’.…”

Improving long‐term outcomes after pediatric renal transplantation by addressing dyslipidemia

“…sd‐LDL has not yet been systematically measured in pediatric renal transplant recipients. This would be an important area to research as data describing the effect of statin therapy on renal transplant patients are conflicting: One study demonstrated that it can lower sd‐LDL, while another did not find it to have any positive effect on coronary calcifications in this cohort …”

Is there relationship between epicardial fat and cardiovascular parameters in incident kidney transplant patients? A post-hoc analysis

“…This is a post-hoc analysis of a randomized, controlled, and open-label study that evaluated the effects of statin use on coronary artery calcification in 100 incident KTX recipients [ 20 ].…”