Meta-analysis of statins in chronic kidney disease: who benefits?

Messow, C.M. and Isles, C. (2017) Meta-analysis of statins in chronic kidney disease: who benefits? QJM: An International Journal of Medicine, 110(8), pp. 493-500. (doi: 10.1093/qjmed/hcx040) (PMID:28340216)

Abstract

Background: Attempts to reduce the burden of vascular disease in advanced chronic kidney disease (CKD) by control of lipids have not been as successful as predicted. Aim: To determine the extent to which the effectiveness of statins varies by kidney class. Design: Meta-analysis. Methods: We selected randomized trials of statin vs. placebo that gave outcomes for CKD3 (eGFR 30–59 ml/min), CKD4 (eGFR 15–29 ml/min), CKD5 (eGFR < 15 ml/min)/5D(dialysis) and transplant patients separately. Data sources were the Cholesterol Triallists’ Treatment Collaboration and previously published meta-analyses. Main outcome measures were major cardiovascular events (MACE), cardiovascular death and all-cause mortality (ACM). Results: A total of 13 studies provided 19 386 participants with CKD3, 2565 with CKD4, 7051 with CKD5/5D and 2102 with a functioning renal transplant. Statins reduced MACE (pooled HR 0.72, 95% CI 0.67–0.78) and ACM (0.82, 0.73–0.91) in CKD3; probably reduced MACE (0.78, 0.62–0.99) in CKD4; and probably reduced cardiovascular death (0.62, 0.40–0.96) in renal transplants. There were no cardiovascular or ACM data in CKD4; there was no convincing evidence of benefit for any outcome in CKD5/5D; and no significant reduction in MACE or ACM in patients with a functioning transplant. Conclusions: Statins are indicated in CKD3, probably indicated in CKD4, not indicated in CKD5/5D and probably indicated in patients with a functioning transplant. Too few patients with CKD4 and renal transplants have been included in lipid lowering trials for confident conclusions to be drawn.

• Item Type: Articles
• Additional Information: This study was supported by a grant from Dumfries and Galloway Health Board to cover cost of statistical support.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Messow, Dr Martina and Isles, Dr Christopher
• Authors: Messow, C.M., and Isles, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: QJM: An International Journal of Medicine
• Publisher: Oxford University Press
• ISSN: 1460-2725
• ISSN (Online): 1460-2393
• Published Online: 14 March 2017
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in QJM: An International Journal of Medicine 110(8):493-500
• Publisher Policy: Reproduced in accordance with the publisher copyright policy