Statins and kidney disease:  is the study of heart and renal protection at the cutting edge of evidence?
OBJECTIVE
Dyslipidaemias are noted in all stages of chronic kidney disease (CKD). Currently most evidence for their treatment comes from secondary retrospective analyses of patient subgroups with CKD recruited into clinical trials powered of hypertensive and dyslipideamic cohorts powered for cardiovascular endpoints.These analyses suggest a number of different beneficial effects of statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) on renal, cardiovascular and mortality outcomes. However, there is disagreement on the impact of interventions at different CKD stages, and on treatment targets.


RESULTS
The Study of Heart and Renal Protection (SHARP) trial published in June 2011 was the first trial specifically powered to investigate atherosclerotic outcomes in CKD patients. It found a 17% overall reduction in major adverse cardiac events in the statin-treated group compared with placebo, yet no effect on any renal outcomes of proteinuria and progressive decline of glomerular filtration rate. Furthermore, the Swedish Web-system for Enhancement and Development of Evidencebased care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) investigators provided further important observational data on the beneficial effect of statins in CKD stages I-IV.


CONCLUSIONS
The evidence that statins have a cardiovascular and mortality benefit in CKD stages I-IV has been reinforced by SHARP, which also definitively shows that there are no special safety concerns for their administration in CKD. However, the utility of the use of statins in patients on dialysis is far from clear, at least in our opinion. The effect of statins on renal outcomes is unconvincing and the evidence does not presently support their use for these indications alone.
Renal and Transplantation Unit, Guy's Hospital, King's Health Partners AHSC, London, UK.
Mark
M
Jenkins
David
D
Goldsmith
D050171:Dyslipidemias / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D050356:Lipid Metabolism; D011507:Proteinuria / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors