Effects of Statin Use in Advanced Chronic Kidney Disease Patients

Abstract

Although statin treatment is recommended for patients with chronic kidney disease (CKD) stages I–IV, its potential benefits have not been reported in advanced CKD patients. Non-diabetic patients with advanced CKD (pre-dialysis patients, estimated glomerular filtration rate <15 mL/min/1.73 m2) were enrolled from a National Health Insurance Research Database with a population of 23 million. Statin users and non-users were matched using propensity scoring and analyzed using Cox proportional hazards models, taking mortality as a competing risk with subsequent end-stage renal disease (ESRD) and statin doses as time-dependent variables. A total of 2551 statin users and 7653 matched statin non-users were identified from a total 14,452 patients with advanced CKD. Taking mortality as a competing risk, statin use did not increase the risk of new-onset diabetes mellitus (NODM) or decrease the risk of de novo major adverse cardiovascular events (MACE), but reduced all-cause mortality (hazard ratio (HR) = 0.59 [95% CI 0.42–0.84], p = 0.004) and sepsis-related mortality (HR = 0.53 [95% CI 0.32–0.87], p = 0.012). For advanced CKD patients, statin was neither associated with increased risks of developing NODM, nor with decreased risk of de novo MACE occurrence, but with a reduced risk of all-cause mortality, mainly septic deaths.

Association of Statin and Its Lipophilicity With Cardiovascular Events in Patients Receiving Chronic Dialysis

“…31 In contrast, other evidence suggested that dialysis patients may have different pathogeneses of arterial lesions and the lesions are so severe that they are unlikely to be meaningfully reduced by statins. 32,33 Statins have shown limited benefit in the primary prevention of CVD and mortality among patients receiving dialysis in the 4D, AURORA, and SHARP trials. [3][4][5] However, a systematic review has suggested that there was no difference between statin use and placebo in the risk of major adverse CVD in patients receiving dialysis (relative risk (RR): 0.95, 95% CI, 0.88-1.03).…”

“…The adjusted HR of hydrophilic rosuvastatin was 0.41 (0.35-0.49), lower than that of lipophilic statins, for which the adjusted HR was around 0.51-0.55. 33 Guidelines suggested that for patients who do not achieve the targeted level of low-density lipoprotein cholesterol (LDL-C), a combination of nonstatin LLA with statin therapy is recommended as an alternative therapeutic option. 37,38 In our cohort, 28.4% of statin users and 10.81% of nonusers were treated with nonstatin LLAs at some time during the study period.…”

Comparing the Effect of Folic Acid and Pentoxifylline on Delaying Dialysis Initiation in Patients with Advanced Chronic Kidney Disease

“…The method of selecting advanced chronic kidney disease patients (CKD stage 5) from the NHIRD database was carried out from several publications [19,20,21]. According to NHI reimbursement regulations, patients with CKD stage 5 whose serum creatinine >6 mg/dL (approximately equivalent to a glomerular filtration rate <15 mL/min/1.73 m 2 ) and a hematocrit <28% should receive ESA to maintain a target hematocrit level not to exceed 36%.…”

Nrf2 in early vascular ageing: Calcification, senescence and therapy

“…Multiple approaches, such as non-calcium phosphate binders, calcium containing phosphate binders [105,106], statins [107][108][109] and vitamin D [110] targeting VC in CKD have been used with varied results and are not curative [111]. A novel approach has been the targeting and removal of senescent cells by senolytic compounds.…”