Statins Have Mixed Effects in CKD Patients
PARIS—Statin medications appear to have different effects on patients with chronic kidney disease (CKD) depending on their disease stage, researchers reported at the 49th Congress of the European Renal Association-European Dialysis and Transplant Association.
Suetonia Palmer, MD, senior lecturer at the University of Otago in Christchurch, New Zealand, and associates elsewhere examined the benefits of statin therapy based on CKD severity. For their study, the group conducted a meta-analysis that included 51,099 adults with CKD who were enrolled in 80 randomized controlled trials that compared statins with placebo or no treatment. Results showed that treatment benefits varied significantly between stages of CKD. Within stages of CKD, treatment effects were consistent.
“We are desperately trying to find treatments that will improve mortality in patients on hemodialysis,” Dr. Palmer said. “In the U.S. registries, about 20% of patients on dialysis die each year, and in most cases because of cardiovascular disease. The literature on the benefits of statins in CKD patients has produced contradictory results, and thus we did a meta-analysis to provide more definitive answers.”
An examination of data on all-cause mortality from the meta-analysis revealed that statins lowered the risk of premature death by 19% in patients with CKD who were not on dialysis but had little or no effect in patients on dialysis. Treatment effects in kidney transplant recipients were uncertain.
Statins reduced major cardiovascular events by 24% in CKD patients not on dialysis but had little or no effect in patients on dialysis. Again, treatment effects in kidney transplant recipients were uncertain.
“Statins don't reduce major cardiovascular events in patients on dialysis probably because cardiovascular events in dialysis patients are more likely to be related to the thickness of the heart muscle and heart failure and not blockage of the arteries,” Dr. Palmer said. “While statins reduce the risk of arterial blockage, arterial blockage is a much less important cause of cardiovascular death in dialysis patients.”
Statins had no significant effects on cancer, myalgia, liver function, or withdrawal from treatment.
The extent of benefit conferred by statins in CKD patients not on dialysis is on a par with that seen in the general population as well as in individuals with cardiovascular disease, she said.
“I am telling clinicians that patients not on dialysis would clearly benefit from a statin,” she added. “However, you are clearly obliged to tell patients once they reach dialysis not that they should stop statins but rather that their chances of clinical benefit are very small.”
She cautioned that the analyses “were limited by reliance on post-hoc subgroup data for earlier stages of CKD.”