Lipid-lowering therapy in persons with chronic kidney disease: a systematic review and meta-analysis.
BACKGROUND
Lipid-lowering therapy is not widely used in persons with chronic kidney disease (CKD) despite a high burden of dyslipidemia and cardiovascular disease in this population.


OBJECTIVE
To synthesize evidence examining the effect of lipid-lowering therapy on clinical outcomes in persons with CKD.


METHODS
MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from January 2000 through November 2011.


METHODS
Randomized, controlled trials (RCTs) comparing lipid-lowering therapy with control treatment in persons with CKD, including subgroup analyses of trials in the general population.


METHODS
Abstracts were screened and data were extracted on study methodology, population, interventions, cardiovascular and kidney outcomes, and adverse events. Data were extracted by one author and confirmed by another. Study quality was determined by consensus. Random-effects model meta-analyses were performed.


RESULTS
18 RCTs, all in adults, met the eligibility criteria. Five RCTs involved CKD populations, and 13 were CKD subgroup analyses from trials in the general population. Sixteen RCTs examined statins, and 2 examined statins plus ezetimibe. Lipid-lowering therapy does not improve kidney outcomes but decreases the risk for cardiac mortality (pooled risk ratio [RR] from 6 trials, 0.82 [95% CI, 0.74 to 0.91]; P< 0.001), cardiovascular events (including revascularization) (pooled RR from 9 trials, 0.78 [CI, 0.71 to 0.86]; P< 0.001), and myocardial infarction (pooled RR from 9 trials, 0.74 [CI, 0.67 to 0.81]; P< 0.001). Significant benefit was also seen for all-cause mortality but was limited by a high degree of heterogeneity. No benefit was found for other cardiovascular outcomes. Rates of adverse events were similar between intervention and comparator groups.


CONCLUSIONS
Lack of data in children, heterogeneity among reviewed studies, and the possibility of selective reporting of outcomes and adverse events.


CONCLUSIONS
Lipid-lowering therapy decreases cardiac death and atherosclerosis-mediated cardiovascular events in persons with CKD.
Renal Section, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 72 East Concord Street, Evans 124, Boston, MA 02118, USA. ashishu@bu.edu
Ashish
A
Upadhyay
Amy
A
Earley
Jenny L
JL
Lamont
Shana
S
Haynes
Christoph
C
Wanner
Ethan M
EM
Balk
D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D002423:Cause of Death; D050171:Dyslipidemias / Q000517:prevention & control*; D006801:Humans; D000960:Hypolipidemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology / Q000628:therapy
D000960:Hypolipidemic Agents