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HMG CoA reductase inhibitors (statins) for dialysis patients.

Abstract

BACKGROUND

Cardiovascular disease accounts for more than half the number of deaths among dialysis patients. The role of HMG CoA reductase inhibitors (statins) in the treatment of dyslipidaemia in dialysis patients is unclear and their safety has not been established.

OBJECTIVES

To assess the benefits and harms of statins in peritoneal dialysis (PD) and haemodialysis patients (HD).

SEARCH STRATEGY

We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled trials (CENTRAL, in The Cochrane Library), the Cochrane Renal Group's specialised register and handsearched reference lists of textbooks, articles and scientific proceedings.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and quasi-RCTs comparing statins with placebo, no treatment or other hypolipidaemic agents in dialysis patients.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model after testing for heterogeneity. The results were expressed as mean difference (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI).

MAIN RESULTS

Fourteen studies (2086 patients) compared statins versus placebo or other lipid lowering agents. Compared to placebo, statins did not decrease all-cause mortality (10 studies, 1884 patients; RR 0.95, 95% CI 0.86 to 1.06) or cardiovascular mortality (9 studies, 1839 patients: RR 0.96, 95% CI 0.65 to 1.40). There was a lower incidence of nonfatal cardiovascular events with statins compared to placebo in haemodialysis patients (1 study, 1255 patients; RR 0.86, 95% CI 0.74 to 0.99). Compared with placebo, statin use was associated with a significantly lower end of treatment average total cholesterol (14 studies, 1823 patients; MD -42.61 mg/dL, 95% CI -53.38 to -31.84), LDL cholesterol (13 studies, 1801 patients; MD -43.06 mg/dL, 95% CI -53.78 to -32.35) and triglycerides (14 studies, 1823 patients: MD -24.01 mg/dL, 95% CI -47.29 to -0.72). There was similar occurrence of rhabdomyolysis and elevated liver function tests with statins in comparison to placebo.

AUTHORS' CONCLUSIONS

Statins decreased cholesterol levels in dialysis patients similar to that of the general population. With the exception of one study, studies were of short duration and therefore the efficacy of statins in decreasing the mortality rate is still unclear. Statins appear to be safe in this high-risk population. Ongoing studies should provide more insight about the efficacy of statins in reducing mortality rates in dialysis patients.

Authors+Show Affiliations

Department of Nephrology and Hypertension, Glickman Urological and Kidney institute, Cleveland Clinic, Cleveland, OH, USA, 44195.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

19588351

Citation

Navaneethan, Sankar D., et al. "HMG CoA Reductase Inhibitors (statins) for Dialysis Patients." The Cochrane Database of Systematic Reviews, 2009, p. CD004289.
Navaneethan SD, Nigwekar SU, Perkovic V, et al. HMG CoA reductase inhibitors (statins) for dialysis patients. Cochrane Database Syst Rev. 2009.
Navaneethan, S. D., Nigwekar, S. U., Perkovic, V., Johnson, D. W., Craig, J. C., & Strippoli, G. F. (2009). HMG CoA reductase inhibitors (statins) for dialysis patients. The Cochrane Database of Systematic Reviews, (3), CD004289. https://doi.org/10.1002/14651858.CD004289.pub4
Navaneethan SD, et al. HMG CoA Reductase Inhibitors (statins) for Dialysis Patients. Cochrane Database Syst Rev. 2009 Jul 8;(3)CD004289. PubMed PMID: 19588351.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - HMG CoA reductase inhibitors (statins) for dialysis patients. AU - Navaneethan,Sankar D, AU - Nigwekar,Sagar U, AU - Perkovic,Vlado, AU - Johnson,David W, AU - Craig,Jonathan C, AU - Strippoli,Giovanni F M, Y1 - 2009/07/08/ PY - 2009/7/10/entrez PY - 2009/7/10/pubmed PY - 2009/8/15/medline SP - CD004289 EP - CD004289 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 3 N2 - BACKGROUND: Cardiovascular disease accounts for more than half the number of deaths among dialysis patients. The role of HMG CoA reductase inhibitors (statins) in the treatment of dyslipidaemia in dialysis patients is unclear and their safety has not been established. OBJECTIVES: To assess the benefits and harms of statins in peritoneal dialysis (PD) and haemodialysis patients (HD). SEARCH STRATEGY: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled trials (CENTRAL, in The Cochrane Library), the Cochrane Renal Group's specialised register and handsearched reference lists of textbooks, articles and scientific proceedings. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs comparing statins with placebo, no treatment or other hypolipidaemic agents in dialysis patients. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model after testing for heterogeneity. The results were expressed as mean difference (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). MAIN RESULTS: Fourteen studies (2086 patients) compared statins versus placebo or other lipid lowering agents. Compared to placebo, statins did not decrease all-cause mortality (10 studies, 1884 patients; RR 0.95, 95% CI 0.86 to 1.06) or cardiovascular mortality (9 studies, 1839 patients: RR 0.96, 95% CI 0.65 to 1.40). There was a lower incidence of nonfatal cardiovascular events with statins compared to placebo in haemodialysis patients (1 study, 1255 patients; RR 0.86, 95% CI 0.74 to 0.99). Compared with placebo, statin use was associated with a significantly lower end of treatment average total cholesterol (14 studies, 1823 patients; MD -42.61 mg/dL, 95% CI -53.38 to -31.84), LDL cholesterol (13 studies, 1801 patients; MD -43.06 mg/dL, 95% CI -53.78 to -32.35) and triglycerides (14 studies, 1823 patients: MD -24.01 mg/dL, 95% CI -47.29 to -0.72). There was similar occurrence of rhabdomyolysis and elevated liver function tests with statins in comparison to placebo. AUTHORS' CONCLUSIONS: Statins decreased cholesterol levels in dialysis patients similar to that of the general population. With the exception of one study, studies were of short duration and therefore the efficacy of statins in decreasing the mortality rate is still unclear. Statins appear to be safe in this high-risk population. Ongoing studies should provide more insight about the efficacy of statins in reducing mortality rates in dialysis patients. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/19588351/HMG_CoA_reductase_inhibitors__statins__for_dialysis_patients_ L2 - https://doi.org/10.1002/14651858.CD004289.pub4 DB - PRIME DP - Unbound Medicine ER -