A Cochrane review [Abstract] 1 included 25 studies with a total of 8 289 subjects. 23 studies compared statins with placebo or no treatment and 2 studies compared statins directly with one or more other statins in dialysis patients. Compared to placebo, statins did not decrease all-cause mortality (RR 0.96, 95% CI 0.90 to 1.02; 13 studies, n=4705) or cardiovascular mortality (RR 0.94, 95% CI 0.84 to 1.06; 13 studies, n=4627), or major cardiovascular events (RR 0.95, 95% CI 0.88 to 1.03; 4 studies, n=7084).
Compared with placebo, statins reduced total cholesterol (MD -44.86 mg/dL (1.14 mmol/L), 95% CI -55.19 to -34.53; 14 studies, n=1803, LDL cholesterol (MD -39.99 mg/d (1.01mmol/L), 95% CI -52.46 to -27.52; 2 studies, n=1747.
Risks of adverse events from statin therapy were uncertain; these included effects on elevated creatine kinase (5 studies, 3067 participants: RR 1.25, 95% CI 0.55 to 2.83) or liver function enzymes (4 studies, 3044 participants; RR 1.09, 95% CI 0.41 to 1.25), withdrawal due to adverse events (9 studies, 1832 participants: RR 1.04, 95% CI 0.87 to 1.25) .
A randomized, double-blind trial 4 compared 4 years of treatment with atorvastatin to placebo in 1255 hemodialysis patients with type 2 diabetes. The primary end point of cardiovascular events (cardiac death, myocardial infarction, and stroke) was non-significantly reduced by 8%. However, long-term effects remained uncertain. Therefore, surviving patients were invited to a follow-up survey done by questionnaire. Median overall follow-up was 11.5 years. Post-trial statin use and low-density lipoprotein cholesterol levels did not differ between groups. Statin treatment non-significantly affected the former primary outcome (RR 0.91; 95% CI 0.78 to 1.07). The risk of all cardiac events combined and the risk of cardiac death were significantly lower in the original statin group compared to placebo (RR 0.83, 95% CI 0.70 to 0.97, and RR 0.80, 95% CI 0.66 to 0.97). No significant effect was detected on cerebrovascular events, fatal stroke, fatal cancer, non-vascular, or all-cause death. No rhabdomyolysis was reported.
A national cohort study 3 in Taiwan evaluated the effect of moderate to high intensity statin on mortality, cardiovascular outcomes in dialysis patients after acute myocatdial infarction. All-cause mortality and cardiovascular outcomes after a 4-year follow-up were analyzed after propensity score matching (PSM).790 patients receiving moderate to high intensity statin therapy were matched with patients not on statins . The benefit of statin on mortality therapy appeared from 1 year to the end of the 4-year follow-up period after hospitalization (statin group versus non-statin group: 22.9% vs. 31.1% at 1 year (HR 0.70; 95% CI 0.58 to 0.85); 48.0% vs. 55.1% at the end of the 4 years (HR 0.76; 95% CI 0.67 to 0.88)). In addition, the impact of statin therapy was stronger in patients with shock at admission (p = 0.035). There were no differences in any individual cardiovascular outcome or adverse event.
A meta-analysis 2 included 31 RCTs with a total of 48 429 patients with chronic kidney disease (CKD) (including patients receiving dialysis). There were 6690 major cardiovascular events and 6653 deaths. Statin therapy produced a 23% RR reduction ( 95% CI 16 to 30) for major cardiovascular events (P<0.001), an 18% RR reduction (8 to 27) for coronary events, and 9% (1 to 16) reduction in cardiovascular or all-cause deaths, but had no significantly effect on stroke (21%, -12 to 44) or no clear effect on kidney failure events (5%, -1 to 10). Adverse events were not significantly increased by statins, including hepatic (RR 1.13, 95% CI 0.92 to 1.39) or muscular disorders (RR 1.02, 95% CI 0.95 to 1.09). Subgroup analysis demonstrated the relative effects of statin therapy in CKD were significantly reduced in people with advanced CKD (P < 0.001) but that the absolute risk reductions were comparable.
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