Statin use is associated with lower inflammation and erythropoietin responsiveness index in hemodialysis patients

Abstract

Patients with end-stage renal disease are prone to inflammation and inflammation is related to erythropoietin-stimulating agent hyporesponsiveness and mortality in this population. Statins have been demonstrated to reduce cardiovascular mortality in selected populations of end-stage renal disease patients. These drugs have pleiotrophic effects such as anti-inflammation. In this retrospective analysis, we determined whether the use of statins improves inflammation and inflammation-related anemia in a cohort of hemodialysis patients. Data were analyzed from Fresenius Medical Care Dialysis Clinics in Turkey between 2005 and 2007. Seventy prevalent hemodialysis patients who were on statins at the start of the study and have been on statins during follow-up (statin users) and 1293 patients who were not on statin at the start of the study and had never been prescribed any lipid-modifying drugs during follow-up (statin nonusers) were included in the study. High-sensitive C-reactive protein levels were significantly decreased in statin users (1.50±1.49 vs. 1.33±1.11 mg/L, P=0.05) compared with nonusers (1.93±3.22 vs. 2.05±2.77 mg/L). Hemoglobin levels and the rate of erythropoietin-stimulating agent users were similar. However, the prescribed erythropoietin-stimulating agent dose (31.6±27.5 vs. 47.3±45.2 U/kg/week, P<0.05) and the erythropoietin response index (2.90±2.73 vs. 4.51±4.48 U/kg/week/Hb, P=0.001) were lower in statin users compared with statin nonusers. On stepwise multiple regression analysis, gender, high-sensitive C-reactive protein, duration of hemodialysis, serum ferritin, and statin use were independent determinants of the erythropoietin responsiveness index. Our results suggest that statin treatment leads to lower inflammation and improves hematopoiesis in hemodialysis patients.

What is statins legacy in chronic kidney disease patients?

“…Despite being a nutritional status index, related to protein intake, its higher levels can also correlate with lower urinary losses, as it is an attributable beneficial effect of statins. 7,20 Statins seem to have a synergic effect with erythropoiesis stimulating agents (ESA) lowering their consumption, in accordance to the Koc M et al, 25 study result. In fact in our population, there were no differences in hemoglobin levels, but it was due to higher dosages of ESA in the group without statins prescription.…”

Statin therapy and erythropoiesis-stimulating agent hyporesponsiveness in patients with nondialysis chronic kidney disease

“…Other studies have consistently demonstrated a mechanistic link between chronic inflammation and ESA hyporesponsiveness, highlighting the association between increased inflammatory markers and a reduced response to ESA therapy. [16–19] In contrast, we did not observe an association between increased hs-CRP levels and ESA hyporesponsiveness as reported in other studies. [18,19] Reasons for this are not clear but may be explained, in part, by the timing of these measures, as baseline hs-CRP levels for statin users were taken and recorded after initiating statin treatment.…”

Attenuation of airway inflammation by simvastatin and the implications for asthma treatment: is the jury still out?

“… 9 For example, statin treatment inhibits the progression of aneurysms associated with degenerative atherosclerosis 33 and diminishes inflammation and related anemia in end-stage renal disease. 34 McKay et al 18 were among the earliest investigators to suggest the possibility of simvastatin for the treatment of allergic airway disease.…”