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Evidence summaries

Statins for People with Chronic Kidney Disease Not Requiring Dialysis

Statins reduce all-cause and cardiovascular mortality in chronic kidney disease patients compared with controls. Especially high-intensity statin therapy may modestly reduce proteinuria and rate of eGFR decline. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 63 studies with a total of 50 725 subjects. In people with chronic kidney disease not requiring dialysis, statins consistently decreased major cardiovascular events (RR 0.72, 95% CI 0.66 to 0.79; 14 studies, n=36 156), all-cause mortality (RR 0.83, 95% CI 0.73 to 0.96; 13 studies, n=34 978) and cardiovascular deaths (RR 0.77, 95% CI 0.69 to 0.87; 8 studies, n=19 112), and MI (RR 0.55, 95% CI 0.42 to 0.73; 10 studies, n=9 475). There were no significant effects on stroke (RR 0.64, 95% CI 0.37 to 1.08; 7 studies, n=9 115), orkidney failure (RR 0.98, 95% CI 0.91 to 1.05, 3 studies, n= 6 704).

A meta-analysis 2 included 57 RCTs with a total of 143 888 participants. Statin treatment did not produce an apparent beneficial effect for kidney failure events (OR 0.98; 95% CI, 0.87 to 1.10; P=0.7) or end-stage renal disease events (OR 0.98; 95% CI, 0.90 to 1.07; P=0.7). However, mean difference for rate of decline in eGFR (0.41, 95% CI 0.11 to 0.70) per year and standardized mean difference for change in proteinuria or albuminuria (-0.65, 95% CI -0.94 to -0.37 standard deviation units) in statin recipients were statistically significant compared to controls. Statin therapy significantly reduced the risk for cardiovascular events (OR 0.69; 95% CI, 0.61 to 0.79; P<0.001).

    References

    • Tunnicliffe DJ, Palmer SC, Cashmore BA, ym. HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis. Cochrane Database Syst Rev 2023;11(11):CD007784 [PubMed]
    • Su X, Zhang L, Lv J et al. Effect of Statins on Kidney Disease Outcomes: A Systematic Review and Meta-analysis. Am J Kidney Dis 2016;67(6):881-92. [PubMed]

Primary/Secondary Keywords