Statin use and sepsis events [corrected] in patients with chronic kidney disease.
BACKGROUND
Patients with chronic kidney disease are at high risk for sepsis and sepsis-related mortality.


OBJECTIVE
To assess whether statin use is associated with a reduction in sepsis events [corrected] in dialysis patients.


METHODS
National prospective cohort study that enrolled 1041 incident dialysis patients at 81 US not-for-profit outpatient dialysis clinics from October 1995 to June 1998, with follow-up to January 2005. Statin use was determined by medical record review. Rates of sepsis events [corrected] between statin users and control patients were compared using multivariate regression models, with adjustment for potential confounders in the overall cohort and in a subcohort in which control patients were matched to statin users according to their likelihood (propensity) to have been prescribed a statin.


METHODS
Sepsis events [corrected] were determined through hospital records from the United States Renal Data System (mean follow-up, 3.4 years).


RESULTS
There were 303 sepsis events [corrected] Rates of sepsis events [corrected] were significantly lower in patients receiving statins (crude incidence rate, 41/1000 patient-years) than in those not receiving statins (crude incidence rate, 110/1000 patient-years) (P<.001). With adjustment for demographics and dialysis modality, statin users were substantially less likely to be subsequently hospitalized for sepsis (incidence rate ratio, 0.41; 95% confidence interval [CI], 0.25-0.68). Further adjustment for comorbidities and laboratory values continued to show this protective association (incidence rate ratio, 0.38; 95% CI, 0.21-0.67). In the propensity-matched subcohort, statin use was even more protective (incidence rate ratio, 0.24; 95% CI, 0.11-0.49).


CONCLUSIONS
Use of statins was strongly and independently associated with a reduction in the risk of sepsis events [corrected] in patients who had chronic kidney disease and were receiving dialysis. Randomized trials of statins in patients with chronic kidney disease should examine the prevention of sepsis as a potentially important benefit.
Gupta
Rajesh
R
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md, USA.
Plantinga
Laura C
LC
Fink
Nancy E
NE
Melamed
Michal L
ML
Coresh
Josef
J
Fox
Caroline S
CS
Levin
Nathan W
NW
Powe
Neil R
NR
D000328:Adult; D000368:Aged; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D018805:Sepsis / Q000453:epidemiology* / Q000517:prevention & control
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors