Benefits and harms of statin therapy for persons with chronic kidney disease: a systematic review and meta-analysis.
BACKGROUND
Statins have uncertain benefits in persons with chronic kidney disease (CKD) because individual trials may have insufficient power to determine whether treatment effects differ with severity of CKD.


OBJECTIVE
To summarize the benefits and harms of statin therapy for adults with CKD and examine whether effects of statins vary by stage of kidney disease.


METHODS
Cochrane and EMBASE databases (inception to February 2012).


METHODS
Randomized trials comparing the effects of statins with placebo, no treatment, or another statin on mortality and cardiovascular outcomes.


METHODS
Two independent reviewers extracted data and assessed risk of bias.


RESULTS
Eighty trials comprising 51099 participants compared statin with placebo or no treatment. Treatment effects varied with stage of CKD. Moderate- to high-quality evidence indicated that statins reduced all-cause mortality (relative risk [RR], 0.81 [95% CI, 0.74 to 0.88]), cardiovascular mortality (RR, 0.78 [CI, 0.68 to 0.89]), and cardiovascular events (RR, 0.76 [CI, 0.73 to 0.80]) in persons not receiving dialysis. Moderate- to high-quality evidence indicated that statins had little or no effect on all-cause mortality (RR, 0.96 [CI, 0.88 to 1.04]), cardiovascular mortality (RR, 0.94 [CI, 0.82 to 1.07]), or cardiovascular events (RR, 0.95 [CI, 0.87 to 1.03]) in persons receiving dialysis. Effects of statins in kidney transplant recipients were uncertain. Statins had little or no effect on cancer, myalgia, liver function, or withdrawal from treatment, although adverse events were evaluated systematically in fewer than half of the trials.


CONCLUSIONS
There was a reliance on post hoc subgroup data for earlier stages of CKD.


CONCLUSIONS
Statins decrease mortality and cardiovascular events in persons with early stages of CKD, have little or no effect in persons receiving dialysis, and have uncertain effects in kidney transplant recipients.
University of Otago, Christchurch, 2 Riccarton Avenue, PO Box 4345, Christchurch 8041, New Zealand.
Suetonia C
SC
Palmer
Jonathan C
JC
Craig
Sankar D
SD
Navaneethan
Marcello
M
Tonelli
Fabio
F
Pellegrini
Giovanni F M
GF
Strippoli
D015982:Bias; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D002423:Cause of Death; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008055:Lipids / Q000097:blood; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D012680:Sensitivity and Specificity
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids