Meta-analysis of statins in chronic kidney disease: who benefits?
BACKGROUND
Attempts to reduce the burden of vascular disease in advanced chronic kidney disease (CKD) by control of lipids have not been as successful as predicted.


OBJECTIVE
To determine the extent to which the effectiveness of statins varies by kidney class.


METHODS
Meta-analysis.


METHODS
We selected randomized trials of statin vs. placebo that gave outcomes for CKD3 (eGFR 30-59 ml/min), CKD4 (eGFR 15-29 ml/min), CKD5 (eGFR < 15 ml/min)/5D(dialysis) and transplant patients separately. Data sources were the Cholesterol Triallists' Treatment Collaboration and previously published meta-analyses. Main outcome measures were major cardiovascular events (MACE), cardiovascular death and all-cause mortality (ACM).


RESULTS
A total of 13 studies provided 19 386 participants with CKD3, 2565 with CKD4, 7051 with CKD5/5D and 2102 with a functioning renal transplant. Statins reduced MACE (pooled HR 0.72, 95% CI 0.67-0.78) and ACM (0.82, 0.73-0.91) in CKD3; probably reduced MACE (0.78, 0.62-0.99) in CKD4; and probably reduced cardiovascular death (0.62, 0.40-0.96) in renal transplants. There were no cardiovascular or ACM data in CKD4; there was no convincing evidence of benefit for any outcome in CKD5/5D; and no significant reduction in MACE or ACM in patients with a functioning transplant.


CONCLUSIONS
Statins are indicated in CKD3, probably indicated in CKD4, not indicated in CKD5/5D and probably indicated in patients with a functioning transplant. Too few patients with CKD4 and renal transplants have been included in lipid lowering trials for confident conclusions to be drawn.
Robertson Centre for Biostatistics, University of Glasgow, Glasgow G12 8QQ, UK.
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Messow
Medical Unit, Dumfries and Galloway Royal Infirmary, Dumfries DG1 4AP, UK.
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Isles
D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D005919:Glomerular Filtration Rate; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D007668:Kidney / Q000503:physiopathology*; D016030:Kidney Transplantation; D008055:Lipids / Q000097:blood; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000628:therapy*; D012720:Severity of Illness Index
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids