A Cochrane review [Abstract] 2 included 5 studies involving a total of 203 subjects with renal disease mostly nephrotic syndrome. Chronic kidney disease (CKD) is a risk factor for stroke and post-stroke mortality. Most outcomes were supported by single study data. One study reported significantly increased high density lipoprotein (HDL) cholesterol among participants in the statin arm compared with the no treatment group (MD 5.40 mg/dL, 95% CI 2.31 to 8.49; 1 trial, n=40). Another study reported higher serum albumin in the statin group compared to those who received no treatment (MD 0.60 g/dL, 95% CI 0.14 to 1.06). No serious adverse events, such as rhabdomyolysis, were reported, however some minor events occurred. One study reported no significant difference in the number of participants with elevated liver enzymes (RR 3.00, 95% CI 0.13 to 69.52; n=40); 3 studies reported liver enzymes remained within the normal range (no data provided). 4 studies reported creatinine phosphokinase (CPK). One study indicated that CPK values fluctuated in both the simvastatin and placebo groups (no data provided); the remaining three studies reported CPK either stayed within the normal range (one study) or there was no significant difference between the lipid lowering agents and placebo.
A meta-analysis 3 evaluated the effects of drug interventions on progression of chronic kidney disease (CKD) in adults with CKD stages 3 and 4. 35 RCTs and over 51 000 patients were included. Data were limited, and heterogeneity varied. eGFR was 6% higher in those taking glycaemic control drugs (ROM 1.06, 95% CI 1.02 to 1.10, I²=0%) and 4% higher in those taking lipid-modifying drugs (ROM 1.04, 95% CI 1.00 to 1.08,I²=88%). Treatment with lipid-modifying drugs led to a 36% reduction in cardiovascular disease and 26% reduction in all-cause mortality.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment, no blinding in half of the studies, and selective reporting).
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