title: Effects of Statins on Renal Outcome in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  HMG CoA reductase inhibitors (statins) are known to prevent cardiovascular disease and improve lipid profiles. However, the effects of statins on renal outcomes, including decline in estimated glomerular filtration rate (eGFR) and proteinuria in patients with chronic kidney disease (CKD), are controversial. This meta-analysis evaluated the impact of statins on renal outcomes in patients with CKD.
  
  
  METHODS
  We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane Databases. The inclusion criteria were published RCT and cohort studies comparing statin therapy to placebo or active controls in patients with CKD (eGFR <60 ml/min/1.73 m(2)) not requiring dialysis. The primary outcome was the differences in the change of eGFR. We also examined change of protein concentration in urine as a secondary outcome. A meta-analysis comparing statin and its control groups and a subgroup analysis examining intensity of statin were performed.
  
  
  RESULTS
  From 142 full-text articles, 10 studies were included in the meta-analysis. Overall, there was a significant difference in rate of eGFR change per year favoring statin group (mean difference (MD) = 0.10 ml/min/1.73 m(2), 95% CI: 0.09 to 0.12). In our subgroup analysis, those who received high-intensity statins had a significant difference in eGFR with a MD of 3.35 (95% CI: 0.91 to 5.79) ml/min/1.73 m(2) compared to control. No significant change in eGFR was found with moderate- and low-intensity statin therapy. Compared with the control group, the statin group did not have a difference in reduction of proteinuria with MD in change of proteinuria of 0.19 gm/day (95% CI: -0.02 to 0.40).
  
  
  CONCLUSIONS
  Overall, there was a difference in change of eGFR between the statin and control group. High-intensity statins were found to improve a decline in eGFR in population with CKD not requiring dialysis compared with control, but moderate- and low-intensity statins were not. Statins were not found to decrease proteinuria in patients with CKD.
authors.affiliation: Department of Internal Medicine, Columbia University College of Physicians and Surgeons, Bassett Medical Center, Cooperstown, New York, United States of America; Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Johns Hopkins University School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Anawin
authors.initials: A
authors.lastname: Sanguankeo
authors.affiliation: Department of Internal Medicine, Columbia University College of Physicians and Surgeons, Bassett Medical Center, Cooperstown, New York, United States of America; Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Sikarin
authors.initials: S
authors.lastname: Upala
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Wisit
authors.initials: W
authors.lastname: Cheungpasitporn
authors.affiliation: Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Patompong
authors.initials: P
authors.lastname: Ungprasert
authors.affiliation: Division of Nephrology, Columbia University College of Physicians and Surgeons, Bassett Medical Center, Cooperstown, New York, United States of America.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Knight
mesh_terms: D016022:Case-Control Studies; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017594:Publication Bias; D012044:Regression Analysis; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors