Efficacy of statins in patients with diabetic nephropathy: a meta-analysis of randomized controlled trials

Abstract

BackgroundThe effects of statins in patients with diabetic nephropathy are controversial. With increasing interest in the potential therapeutic role of statins in diabetic nephropathy, it is essential to evaluate its real effects.MethodsPubMed, EMBASE, Web of Science databases, Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure were systematically searched for randomized controlled trials (RCTs) of statins in patients with diabetic nephropathy.ResultsFourteen trials with 2866 participants were included in our meta-analysis. Compared with placebo, albuminuria and urinary albumin excretion rates in the statin group were reduced by 0.46 [95 % confidence interval (CI),−0.68 to −0.25, P < 0.0001] and 1.68 (95 % CI, −3.23 to −0.12, P = 0.03), respectively. The reduction of albuminuria was greater in patients of type 2 diabetes mellitus with diabetic nephropathy [standardized mean difference (SMD), −0.56; 95 % CI, −0.80 to −0.32, P < 0.00001] and the decrease was significant during the 1 to 3 years period of statin therapy (SMD, −0.57; 95 % CI, −0.95 to −0.19, P = 0.003). Subgroup analysis demonstrated the effects of statins were much stronger in subjects with pathologic albuminuria: change of −0.71 (95 % CI, −1.09 to −0.33, P = 0.0003) for those with urinary protein excretion 30 to 300 mg/day, −0.37 (95 % CI, −0.67 to −0.06, P = 0.02) for those with excretion more than 300 mg/day and −0.29 (95 % CI, −0.78 to 0.21, P = 0.26) for those with excretion less than 30 mg/day. In contrast, statins did not significantly reduce estimated glomerular filtration rate, serum creatinine and blood urea nitrogen levels.ConclusionsStatins decrease the albuminuria and urinary albumin excretion rates significantly. The efficacy of statins on renal function is time dependent and better in type 2 diabetic patients with nephropathy.

Role of the sodium‐hydrogen exchanger in mediating the renal effects of drugs commonly used in the treatment of type 2 diabetes

“…[208][209][210] These drugs also have had favourable effects on renal function in clinical trials, particularly in patients with diabetes; long-term therapy reduces albuminuria and retards the decline in glomerular filtration rate. 9,211,212 Similar benefits to the kidney have been noted in experimental diabetes; in these studies, statins prevent oxidative stress and cellular injury as well as the inflammatory, proliferative and fibrotic changes that are characteristic of diabetic chronic renal disease. [213][214][215][216][217][218][219][220] These favourable effects cannot be fully explained by the actions of these drugs on lipids; other lipid-lowering drugs exert little or modest effects on albuminuria and may worsen renal function in patients with diabetes.…”

“…Inhibitors of HMG CoA reductase (eg, pravastatin, atorvastatin and rosuvastatin) are routinely prescribed to patients with diabetes or glucose intolerance, because they reduce the risk of major atherosclerotic ischemic events . These drugs also have had favourable effects on renal function in clinical trials, particularly in patients with diabetes; long‐term therapy reduces albuminuria and retards the decline in glomerular filtration rate . Similar benefits to the kidney have been noted in experimental diabetes; in these studies, statins prevent oxidative stress and cellular injury as well as the inflammatory, proliferative and fibrotic changes that are characteristic of diabetic chronic renal disease .…”

“…Conversely, drugs can have meaningful early effects on renal function that exceed those expected from modest changes in glycated haemoglobin . Furthermore, certain treatments that have no antihyperglycaemic effect at all can still ameliorate the development of albuminuria and/or renal insufficiency . Although various possibilities have been proposed and explored, studies to date have not identified a single biological mechanism that might underlie the renal effects of drugs commonly prescribed to patients with type 2 diabetes.…”

Non-alcoholic steatohepatitis and type 2 diabetes mellitus: the effects of weight loss versus drug treatment

“…Chronic kidney disease (CKD) has been associated with NAFLD/NASH, especially in T2DM patients, thus further increasing individual's CV risk [13][14][15] . Statins and some antidiabetic drugs, including some sodium glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists, have been shown to improve albuminuria and renal dysfunction, as well as prevent/delay CKD progression [16][17][18][19][20][21][22] . Oshakbayev et al 1 do not provide any data on kidney function despite commenting on changes in urine composition.…”

Statin use in patients with diabetes: one drug, multiple benefits

“…Apart from LDL-C risk reduction, statins may exert further benefits in DM patients [3]. In this context, it has been shown that statins can improve urinary albumin excretion rates and albuminuria, especially in type 2 DM patients with diabetic nephropathy [4]. Statins may also minimize the risk for contrast-induced acute kidney injury (CI-AKI) in DM patients [5].…”