Low-dose atorvastatin in severe chronic kidney disease patients: a randomized, controlled endpoint study.
OBJECTIVE
There have been no endpoint studies with statins for patients with severe renal failure. The purpose of this prospective, open, randomized, controlled study was to investigate whether atorvastatin (10 mg/day) would alter cardiovascular endpoints and the overall mortality rate of patients with chronic kidney disease stage 4 or 5 (creatinine clearance < 30 ml/min).


METHODS
The study subjects comprised 143 patients who were randomized either to placebo (controls; n=73; mean age 69.5 years) or to treatment with atorvastatin (n=70; mean age 67.9 years). The patients included were either non-dialysis (n=33), haemodialysis (n=97) or peritoneal dialysis (n=13) patients. Analysis focused on the primary endpoints of all-cause mortality, non-lethal acute myocardial infarction, coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty. Statistical analysis for endpoint data was mainly by intention-to-treat.


RESULTS
Primary endpoints occurred in 74% of the subjects. There was no difference in outcome between the control and atorvastatin groups. The 5-year endpoint-free survival rate from study entry was 20%. Atorvastatin was withdrawn in 20% of patients due to unacceptable side-effects. In the atorvastatin group, low-density lipoprotein (LDL) cholesterol was reduced by 35% at 1 month and then sustained. The controls showed a progressive reduction in LDL cholesterol until 36 months.


CONCLUSIONS
Although atorvastatin reduced total and LDL cholesterol effectively it was not beneficial regarding the long-term outcomes of cardiovascular endpoints or survival. In contrast to other patient groups, patients with severe chronic kidney disease, especially those on dialysis, seem to derive limited benefit from this lower dose of atorvastatin.
Stegmayr
B G
BG
Department of Internal Medicine, Division of Nephrology, University Hospital Umea, 901 85 Umea, Sweden. bernd.stegmayr@medicin.umu.se
Brännström
M
M
Bucht
S
S
Crougneau
V
V
Dimeny
E
E
Ekspong
A
A
Eriksson
M
M
Granroth
B
B
Gröntoft
K C
KC
Hadimeri
H
H
Holmberg
B
B
Ingman
B
B
Isaksson
B
B
Johansson
G
G
Lindberger
K
K
Lundberg
L
L
Mikaelsson
L
L
Olausson
E
E
Persson
B
B
Stenlund
H
H
Wikdahl
A M
AM
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000069059:Atorvastatin; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control* / Q000628:therapy; D001026:Coronary Artery Bypass; D004305:Dose-Response Relationship, Drug; D005260:Female; D006538:Heptanoic Acids / Q000008:administration & dosage*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality*; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D011446:Prospective Studies; D011758:Pyrroles / Q000008:administration & dosage*
D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin