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[Statins in patients with kidney failure: efficacy, tolerance, and prescription guidelines in patients with chronic kidney disease and renal transplant].
Presse Med. 2006 Feb; 35(2 Pt 1):219-29.PM

Abstract

BACKGROUND

Chronic kidney disease (CKD) is extremely common in adults, although often undiagnosed and thus untreated. Cardiovascular disease is the leading cause of death among patients with CKD and reducing its risk in this population is an important priority. Dyslipidemia is almost always present when proteinuria is above 3 gr/24 hours. Roughly two thirds of all patients with end-stage renal failure and kidney transplants suffer from dyslipidemia and should receive lipid-lowering therapy, as suggested by recent Afssaps (French drug agency) and NKF-K/DOQI (National Kidney Foundation-Kidney Disease Outcomes Quality Initiative) guidelines. We reviewed recent studies on efficacy, tolerability and prescription recommendations of statins in CKD and renal transplant patients.

METHODS

We searched Medline, the international medical database, to conduct a systematic review of the literature on the efficacy and tolerability of statins in CKD and renal transplant patients and on specific recommendations for dosage adjustments in this population.

RESULTS

The efficacy of statins in decreasing total cholesterol and LDL-cholesterol levels in dialysis and renal transplant patients is similar to that in the general population. On the other hand, large-scale randomized clinical trials among CKD (4D) and renal transplant (ALERT) patients do not demonstrate that statins significantly decrease rates of cardiovascular disease. They have a beneficial effect on proteinuria and lower the rate of kidney function deterioration in patients with dyslipidemia. Early introduction of a statin in transplant patients did not lead to improved kidney function or prevent loss of the graft. Although most statins are not excreted by the kidneys, the dosage of some must be adapted in CKD patients because of pharmacokinetic modifications induced by renal impairment.

CONCLUSION

Statins at appropriately adapted doses have the same efficacy in CKD patients as in subjects with normal kidney function, and tolerance is not a problem. Their effectiveness in cardiovascular prevention in this population has not been demonstrated to date. Results about statin-induced kidney protection are encouraging but further and more specific studies are needed.

Authors+Show Affiliations

Service de néphrologie, Hôpital Pitié-Salpêtrière, Paris.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Review
Systematic Review

Language

fre

PubMed ID

16493350

Citation

Karie, Svetlana, et al. "[Statins in Patients With Kidney Failure: Efficacy, Tolerance, and Prescription Guidelines in Patients With Chronic Kidney Disease and Renal Transplant]." Presse Medicale (Paris, France : 1983), vol. 35, no. 2 Pt 1, 2006, pp. 219-29.
Karie S, Launay-Vacher V, Deray G, et al. [Statins in patients with kidney failure: efficacy, tolerance, and prescription guidelines in patients with chronic kidney disease and renal transplant]. Presse Med. 2006;35(2 Pt 1):219-29.
Karie, S., Launay-Vacher, V., Deray, G., & Isnard-Bagnis, C. (2006). [Statins in patients with kidney failure: efficacy, tolerance, and prescription guidelines in patients with chronic kidney disease and renal transplant]. Presse Medicale (Paris, France : 1983), 35(2 Pt 1), 219-29.
Karie S, et al. [Statins in Patients With Kidney Failure: Efficacy, Tolerance, and Prescription Guidelines in Patients With Chronic Kidney Disease and Renal Transplant]. Presse Med. 2006;35(2 Pt 1):219-29. PubMed PMID: 16493350.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Statins in patients with kidney failure: efficacy, tolerance, and prescription guidelines in patients with chronic kidney disease and renal transplant]. AU - Karie,Svetlana, AU - Launay-Vacher,Vincent, AU - Deray,Gilbert, AU - Isnard-Bagnis,Corinne, PY - 2006/2/24/pubmed PY - 2006/3/25/medline PY - 2006/2/24/entrez SP - 219 EP - 29 JF - Presse medicale (Paris, France : 1983) JO - Presse Med VL - 35 IS - 2 Pt 1 N2 - BACKGROUND: Chronic kidney disease (CKD) is extremely common in adults, although often undiagnosed and thus untreated. Cardiovascular disease is the leading cause of death among patients with CKD and reducing its risk in this population is an important priority. Dyslipidemia is almost always present when proteinuria is above 3 gr/24 hours. Roughly two thirds of all patients with end-stage renal failure and kidney transplants suffer from dyslipidemia and should receive lipid-lowering therapy, as suggested by recent Afssaps (French drug agency) and NKF-K/DOQI (National Kidney Foundation-Kidney Disease Outcomes Quality Initiative) guidelines. We reviewed recent studies on efficacy, tolerability and prescription recommendations of statins in CKD and renal transplant patients. METHODS: We searched Medline, the international medical database, to conduct a systematic review of the literature on the efficacy and tolerability of statins in CKD and renal transplant patients and on specific recommendations for dosage adjustments in this population. RESULTS: The efficacy of statins in decreasing total cholesterol and LDL-cholesterol levels in dialysis and renal transplant patients is similar to that in the general population. On the other hand, large-scale randomized clinical trials among CKD (4D) and renal transplant (ALERT) patients do not demonstrate that statins significantly decrease rates of cardiovascular disease. They have a beneficial effect on proteinuria and lower the rate of kidney function deterioration in patients with dyslipidemia. Early introduction of a statin in transplant patients did not lead to improved kidney function or prevent loss of the graft. Although most statins are not excreted by the kidneys, the dosage of some must be adapted in CKD patients because of pharmacokinetic modifications induced by renal impairment. CONCLUSION: Statins at appropriately adapted doses have the same efficacy in CKD patients as in subjects with normal kidney function, and tolerance is not a problem. Their effectiveness in cardiovascular prevention in this population has not been demonstrated to date. Results about statin-induced kidney protection are encouraging but further and more specific studies are needed. SN - 0755-4982 UR - https://www.unboundmedicine.com/medline/citation/16493350/[Statins_in_patients_with_kidney_failure:_efficacy_tolerance_and_prescription_guidelines_in_patients_with_chronic_kidney_disease_and_renal_transplant]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0755-4982(06)74557-2 DB - PRIME DP - Unbound Medicine ER -