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Statins for improving renal outcomes

Evidence summaries
24.10.2017
Editors

Level of evidence: A

Statins may have a small effect in slowing the rate of loss of kidney function, especially in patients with cardiovascular disease. However, statins reduce all-cause and cardiovascular mortality in patients with chronic kidney disease.

A Cochrane review «»1 «Palmer SC, Navaneethan SD, Craig JC et al. HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis. Cochrane Database Syst Rev 2014;(5):CD007784. »3 included 50 studies with a total of 45 285 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; 13 studies, n=36 033), all-cause mortality (RR 0.79, 95% CI 0.69 to 0.91; 10 studies, n=28 276) and cardiovascular deaths (RR 0.77, 95% CI 0.69 to 0.87; 7 studies, n=19 059), and MI (RR 0.55, 95% CI 0.42 to 0.72; 8 studies, n=9 018). Statins had uncertain effects on stroke (RR 0.62, 95% CI 0.35 to 1.12; 5 studies, n=8 658).There was no significant improvement in creatinine clearance. The incidence of rhabdomyolysis, elevated liver enzymes and withdrawal rates due to adverse events were not significantly different between patients when reported.

A systematic review and meta-analysis «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. »2 assessing the efficacy of statins on kidney outcomes included 57 studies 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 to1.10; P=0.7) or end-stage renal disease events (OR 0.98, 95% CI 0.90 to1.07; P=0.7). However, compared with control or placebo, it slowed down the rate of decline in eGFR (mean difference [MD] 0.41, 95% CI 0.11 to 0.70 mL/min/1.73m per year) and the change in proteinuria or albuminuria (MD -0.65, 95% CI -0.94 to -0.37). In addition, statin therapy significantly reduced the risk for cardiovascular events (OR, 0.69, 95% CI 0.61 to 0.79; P<0.001).

A systematic review «Sandhu S, Wiebe N, Fried LF, Tonelli M. Statins for improving renal outcomes: a meta-analysis. J Am Soc Nephrol 2006 Jul;17(7):2006-16. »1 including 27 studies with a total of 39 704 subjects was abstracted in DARE. Studies included patients with cardiovascular disease (CVD), glomerulonephritis, diabetes, hypertension, hyperlipidaemia and general patients. Studies of patients with end-stage renal disease were excluded. The included studies evaluated atorvastatin, pravastatin, fluvastatin, simvastatin, lovastatin and cerivastatin. Overall, the change in the weighted mean differences for eGFR was statistically significant (1.22 ml/min per yr slower in statin recipients; 95% CI 0.44 to 2.00). There was substantial heterogeneity (I-squared 96%). The effect of statins remained statistically significant with a smaller treatment effect when only higher quality studies were analysed. In subgroup analysis, the benefit of statin therapy was statistically significant in studies of participants with CVD (0.93 ml/min per yr slower than control subjects; 95% CI 0.10 to 1.76) but was non-significant for studies of participants with diabetic or hypertensive kidney disease or glomerulonephritis. There were no significant differences between statins and control in the rate of change in proteinuria (reduction in WMD 0.37 g/24 hours, 95% CI -0.75 to 0.02) or albuminuria (reduction in WMD -0.02 g/24 hours, 95% CI -0.06 to 0.02); substantial heterogeneity was found (I-squared 83% and 92%, respectively).

This document is linked to the following articles:

  • Dyslipidemiat 1

References

  1. Sandhu S, Wiebe N, Fried LF, Tonelli M. Statins for improving renal outcomes: a meta-analysis. J Am Soc Nephrol 2006 Jul;17(7):2006-16. «PMID: 16762986»PubMed «DARE-12006002842»DARE
  2. 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. «PMID: 26905361»PubMed
  3. Palmer SC, Navaneethan SD, Craig JC et al. HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis. Cochrane Database Syst Rev 2014;(5):CD007784. «PMID: 24880031»PubMed
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