title: Statins decrease all-cause mortality only in CKD patients not requiring dialysis therapy--a meta-analysis of 11 randomized controlled trials involving 21,295 participants.
abstract: The available studies have reported the benefits of statins on all-cause and cardiovascular mortality in chronic kidney disease (CKD) patients. However studies in end-stage renal disease patients on dialysis yielded conflicting results. Therefore, we performed a meta-analysis and provide the most reliable trial data to date on the impact of statin therapy on cardiovascular events and death from all causes in CKD patients. Data from PubMed, Web of Science, Cochrane Library, and Scopus for the years 1966 to October 2012 were searched. The final meta-analysis included 11 randomized controlled trials involving 21,295 participants with CKD. Among them 6857 were on dialysis. The use of statins in subjects with non-dialysis-dependent CKD resulted in a marked reduction in death from all causes (relative risk [RR]: 0.66; 95% confidence interval [CI]: 0.55-0.79; p<0.0001), cardiac causes (RR: 0.69; 95%CI: 0.55-0.68; p=0.0012), cardiovascular events (RR: 0.55; 95%CI: 0.4-0.75; p=0.0001) and stroke (RR: 0.66; 95%CI: 0.5-0.88; p=0.0022). The use of statins in dialysis-dependent CKD patients resulted in a non-significant effect on death from all causes (RR: 0.99; 95%CI: 0.88-1.11; p=0.85) and stroke (RR: 1.31; 95%CI: 0.9-1.89; p>0.05), but had the effect of reducing death from cardiac causes (RR: 0.79; 95%CI: 0.64-0.98; p<0.05) and cardiovascular events (RR: 0.81; 95%CI: 0.7-0.94; p<0.05). In conclusion, the use of statins should be indicated in cardiovascular disease prevention especially in patients with non-dialysis-dependent CKD. According to the very limited data the obtained results suggest caution in expecting a reduction in cardiovascular events in patients on dialysis.
authors.affiliation: Department of Internal Medicine and Cardiological Rehabilitation, Medical University of Lodz, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Barylski
authors.forename: Shekoufeh
authors.initials: S
authors.lastname: Nikfar
authors.forename: Dimitri P
authors.initials: DP
authors.lastname: Mikhailidis
authors.forename: Peter P
authors.initials: PP
authors.lastname: Toth
authors.forename: Pooneh
authors.initials: P
authors.lastname: Salari
authors.forename: Kausik K
authors.initials: KK
authors.lastname: Ray
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.forename: Manfredi
authors.initials: M
authors.lastname: Rizzo
authors.forename: Jacek
authors.initials: J
authors.lastname: Rysz
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abdollahi
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholls
authors.forename: Maciej
authors.initials: M
authors.lastname: Banach
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy*; D020521:Stroke / Q000150:complications / Q000401:mortality / Q000517:prevention & control
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors