title: Progression of kidney disease in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin versus usual care: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
abstract: BACKGROUND
  Dyslipidemia is common in patients with chronic kidney disease. The role of statin therapy in the progression of kidney disease is unclear.
  
  
  METHODS
  Prospective randomized clinical trial, post hoc analyses.
  
  
  METHODS
  10,060 participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (lipid-lowering component) stratified by baseline estimated glomerular filtration rate (eGFR): less than 60, 60 to 89, and 90 or greater mL/min/1.73 m(2). Mean follow-up was 4.8 years.
  
  
  METHODS
  Randomized; pravastatin, 40 mg/d, or usual care.
  
  
  METHODS
  Total, high-density lipoprotein, and low-density lipoprotein cholesterol; end-stage renal disease (ESRD), eGFR.
  
  
  RESULTS
  Through year 6, total cholesterol levels decreased in the pravastatin (-20.7%) and usual-care groups (-11.2%). No significant differences were seen between groups for rates of ESRD (1.36 v 1.45/100 patient-years; P = 0.9), composite end points of ESRD and 50% or 25% decrease in eGFR, or rate of change in eGFR. Findings were consistent across eGFR strata. In patients with eGFR of 90 mL/min/1.73 m(2) or greater, the pravastatin arm tended to have a higher eGFR.
  
  
  CONCLUSIONS
  Proteinuria data unavailable, post hoc analyses, unconfirmed validity of the Modification of Diet in Renal Disease Study equation in normal eGFR range, statin drop-in rate in usual-care group with small cholesterol differential between groups.
  
  
  CONCLUSIONS
  In hypertensive patients with moderate dyslipidemia and decreased eGFR, pravastatin was not superior to usual care in preventing clinical renal outcomes. This was consistent across the strata of baseline eGFR. However, benefit from statin therapy may depend on the degree of the cholesterol level decrease achieved.
authors.affiliation: Case Western Reserve University, University Hospitals of Cleveland Case Medical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.forename: Charles
authors.initials: C
authors.lastname: Baimbridge
authors.forename: Barry R
authors.initials: BR
authors.lastname: Davis
authors.forename: Joshua
authors.initials: J
authors.lastname: Barzilay
authors.forename: Jan N
authors.initials: JN
authors.lastname: Basile
authors.forename: Mario A
authors.initials: MA
authors.lastname: Henriquez
authors.forename: Anne
authors.initials: A
authors.lastname: Huml
authors.forename: Nelson
authors.initials: N
authors.lastname: Kopyt
authors.forename: Gail T
authors.initials: GT
authors.lastname: Louis
authors.forename: Sara L
authors.initials: SL
authors.lastname: Pressel
authors.forename: Clive
authors.initials: C
authors.lastname: Rosendorff
authors.forename: Sithiporn
authors.initials: S
authors.lastname: Sastrasinh
authors.forename: Carol
authors.initials: C
authors.lastname: Stanford
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D002784:Cholesterol / Q000097:blood; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D006973:Hypertension / Q000150:complications*; D015994:Incidence; D007674:Kidney Diseases / Q000209:etiology* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017035:Pravastatin / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D002784:Cholesterol; D017035:Pravastatin