HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis

Abstract

BACKGROUND: Cardiovascular disease (CVD) is the most frequent cause of death in people with early stages of chronic kidney disease (CKD), for whom the absolute risk of cardiovascular events is similar to people who have existing coronary artery disease. This is an update of a review published in 2009, and includes evidence from 27 new studies (25,068 participants) in addition to the 26 studies (20,324 participants) assessed previously; and excludes three previously included studies (107 participants). This updated review includes 50 studies (45,285 participants); of these 38 (37,274 participants) were meta-analysed. OBJECTIVE: To evaluate the benefits (such as reductions in all-cause and cardiovascular mortality, major cardiovascular events, MI and stroke; and slow progression of CKD to end-stage kidney disease (ESKD)) and harms (muscle and liver dysfunction, withdrawal, and cancer) of statins compared with placebo, no treatment, standard care or another statin in adults with CKD who were not on dialysis. METHODS:Search methods: We searched the Cochrane Renal Group's Specialised Register to 5 June 2012 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs that compared the effects of statins with placebo, no treatment, standard care, or other statins, on mortality, cardiovascular events, kidney function, toxicity, and lipid levels in adults with CKD not on dialysis were the focus of our literature searches. Data collection and analysis: Two or more authors independently extracted data and assessed study risk of bias. Treatment effects were expressed as mean difference (MD) for continuous outcomes (lipids, creatinine clearance and proteinuria) and risk ratio (RR) for dichotomous outcomes (major cardiovascular events, all-cause mortality, cardiovascular mortality, fatal or non-fatal myocardial infarction (MI), fatal or nonfatal stroke, ESKD, elevated liver enzymes, rhabdomyolysis, cancer and withdrawal rates) with 95% confidence intervals (CI). MAIN RESULTS: We included 50 studies (45,285 participants): 47 studies (39,820 participants) compared statins with placebo or no treatment and three studies (5547 participants) compared two different statin regimens in adults with CKD who were not yet on dialysis. We were able to meta-analyse 38 studies (37,274 participants). The risk of bias in the included studies was high. Seven studies comparing statins with placebo or no treatment had lower risk of bias overall;

2016 European Guidelines on cardiovascular disease prevention in clinical practice

“…367 Statin therapy has a beneficial effect on CVD outcomes in CKD 368 and in some studies slows the rate of kidney function loss. 369,370 Similar data have been observed for combination therapy of a statin with ezetimibe, but not for ezetimibe alone. 368 For patients with end-stage renal disease, we recommend that hypolipidaemic therapy should not be initiated.…”

Treatment options for dyslipidemia in chronic kidney disease and for protection from contrast-induced nephropathy

“…However, statins had uncertain effects on the progression of CKD [13]. This lack of clear effect of statins on CKD progression was also reported in another meta-analysis [14] and might be due to disparate effects on CKD progression of different statins and/or different statin doses [13].…”

“…These results were verified by a Cochrane analysis of 50 studies (45,285 participants not requiring dialysis) [13]. Compared with placebo, statin treatment reduced major CVD events ( [13]. The incidence of adverse effects was low [13].…”

“…CVD history and a lower baseline kidney function were associated with higher CVD morbidity [12]. These results were verified by a Cochrane analysis of 50 studies (45,285 participants not requiring dialysis) [13]. Compared with placebo, statin treatment reduced major CVD events ( [13].…”

“…Compared with placebo, statin treatment reduced major CVD events ( [13]. The incidence of adverse effects was low [13]. However, statins had uncertain effects on the progression of CKD [13].…”