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Effects of Statins on Renal Outcome in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis.
PLoS One. 2015; 10(7):e0132970.Plos

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.

MATERIALS AND 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).

CONCLUSION

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.

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Authors+Show Affiliations

Sanguankeo A
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.
Upala S
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.
Cheungpasitporn W
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America.
Ungprasert P
Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, United States of America.
Knight EL
Division of Nephrology, Columbia University College of Physicians and Surgeons, Bassett Medical Center, Cooperstown, New York, United States of America.

MeSH

Case-Control StudiesFemaleGlomerular Filtration RateHumansHydroxymethylglutaryl-CoA Reductase InhibitorsKidneyMaleMiddle AgedPublication BiasRegression AnalysisRenal Insufficiency, ChronicTreatment Outcome

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

26151753

Citation

Sanguankeo, Anawin, et al. "Effects of Statins On Renal Outcome in Chronic Kidney Disease Patients: a Systematic Review and Meta-Analysis." PloS One, vol. 10, no. 7, 2015, pp. e0132970.
Sanguankeo A, Upala S, Cheungpasitporn W, et al. Effects of Statins on Renal Outcome in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis. PLoS One. 2015;10(7):e0132970.
Sanguankeo, A., Upala, S., Cheungpasitporn, W., Ungprasert, P., & Knight, E. L. (2015). Effects of Statins on Renal Outcome in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis. PloS One, 10(7), e0132970. https://doi.org/10.1371/journal.pone.0132970
Sanguankeo A, et al. Effects of Statins On Renal Outcome in Chronic Kidney Disease Patients: a Systematic Review and Meta-Analysis. PLoS One. 2015;10(7):e0132970. PubMed PMID: 26151753.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of Statins on Renal Outcome in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis. AU - Sanguankeo,Anawin, AU - Upala,Sikarin, AU - Cheungpasitporn,Wisit, AU - Ungprasert,Patompong, AU - Knight,Eric L, Y1 - 2015/07/07/ PY - 2015/03/24/received PY - 2015/06/19/accepted PY - 2015/7/8/entrez PY - 2015/7/8/pubmed PY - 2016/4/12/medline SP - e0132970 EP - e0132970 JF - PloS one JO - PLoS One VL - 10 IS - 7 N2 - 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. MATERIALS AND 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). CONCLUSION: 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. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/26151753/Effects_of_Statins_on_Renal_Outcome_in_Chronic_Kidney_Disease_Patients:_A_Systematic_Review_and_Meta_Analysis_ DB - PRIME DP - Unbound Medicine ER -