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Effect of Statins on Kidney Disease Outcomes: A Systematic Review and Meta-analysis.
Am J Kidney Dis. 2016 Jun; 67(6):881-92.AJ

Abstract

BACKGROUND

The effects of statin administration on kidney disease outcomes remain controversial. We undertook a systematic review and meta-analysis to assess the efficacy of statins on kidney outcomes.

STUDY DESIGN

We conducted a meta-analysis of randomized controlled trials (RCTs) using MEDLINE (1946 to August 31, 2015), EMBASE (1966 to August 31, 2015), and the Cochrane Library database (no date restriction).

SETTING & POPULATION

Adults who were not receiving dialysis, for whom kidney disease outcomes were reported.

SELECTION CRITERIA FOR STUDIES

RCTs in which statins were given for at least 6 months and kidney outcomes were measured.

INTERVENTION

Statins versus control, including placebo, usual care, and different types or doses of statins.

OUTCOMES

Kidney failure events, rate of change in estimated glomerular filtration rate (eGFR) per year, change in proteinuria or albuminuria, and, in patients with chronic kidney disease, major cardiovascular events.

RESULTS

57 eligible studies with 143,888 participants were included. Statin treatment did not produce an apparent beneficial effect for kidney failure events (OR, 0.98; 95% CI, 0.87-1.10; P=0.7) or end-stage renal disease events (OR, 0.98; 95% CI, 0.90-1.07; P=0.7). However, mean difference for rate of decline in eGFR (0.41 [95% CI, 0.11-0.70] mL/min/1.73m(2) per year slower in statin recipients) and standardized mean difference for change in proteinuria or albuminuria (-0.65 [95% CI, -0.94 to -0.37] standard deviation units, statin recipients vs controls) were statistically significant. In addition, statin therapy significantly reduced the risk for cardiovascular events (OR, 0.69; 95% CI, 0.61-0.79; P<0.001) in patients with chronic kidney disease.

LIMITATIONS

Inclusion of several post hoc analyses from large RCTs and substantial heterogeneity in secondary outcome analyses.

CONCLUSIONS

Statin therapy does not reduce the risk for kidney failure events in adults not receiving dialysis for whom kidney disease outcomes were reported, but may modestly reduce proteinuria and rate of eGFR decline.

Authors+Show Affiliations

Renal Division, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China; Renal Division, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, Taiyuan, China.Renal Division, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China; Renal Division, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China.Renal Division, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China. Electronic address: jichenglv75@gmail.com.Renal Division, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.Renal Division, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.Renal Division, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.Renal Division, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

26905361

Citation

Su, Xiaole, et al. "Effect of Statins On Kidney Disease Outcomes: a Systematic Review and Meta-analysis." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 67, no. 6, 2016, pp. 881-92.
Su X, Zhang L, Lv J, et al. Effect of Statins on Kidney Disease Outcomes: A Systematic Review and Meta-analysis. Am J Kidney Dis. 2016;67(6):881-92.
Su, X., Zhang, L., Lv, J., Wang, J., Hou, W., Xie, X., & Zhang, H. (2016). Effect of Statins on Kidney Disease Outcomes: A Systematic Review and Meta-analysis. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 67(6), 881-92. https://doi.org/10.1053/j.ajkd.2016.01.016
Su X, et al. Effect of Statins On Kidney Disease Outcomes: a Systematic Review and Meta-analysis. Am J Kidney Dis. 2016;67(6):881-92. PubMed PMID: 26905361.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of Statins on Kidney Disease Outcomes: A Systematic Review and Meta-analysis. AU - Su,Xiaole, AU - Zhang,Lu, AU - Lv,Jicheng, AU - Wang,Jinwei, AU - Hou,Wanyin, AU - Xie,Xinfang, AU - Zhang,Hong, Y1 - 2016/02/20/ PY - 2015/06/24/received PY - 2016/01/11/accepted PY - 2016/2/25/entrez PY - 2016/2/26/pubmed PY - 2017/6/1/medline KW - Chronic kidney disease (CKD) KW - albuminuria KW - atorvastatin KW - cardiovascular events KW - dyslipidemia KW - estimated glomerular filtration rate (eGFR) KW - hydroxymethylglutaryl-CoA reductase inhibitor KW - kidney disease outcomes KW - kidney failure KW - lipid lowering KW - pravastatin KW - proteinuria KW - rosuvastatin KW - simvastatin KW - statins KW - systematic review SP - 881 EP - 92 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 67 IS - 6 N2 - BACKGROUND: The effects of statin administration on kidney disease outcomes remain controversial. We undertook a systematic review and meta-analysis to assess the efficacy of statins on kidney outcomes. STUDY DESIGN: We conducted a meta-analysis of randomized controlled trials (RCTs) using MEDLINE (1946 to August 31, 2015), EMBASE (1966 to August 31, 2015), and the Cochrane Library database (no date restriction). SETTING & POPULATION: Adults who were not receiving dialysis, for whom kidney disease outcomes were reported. SELECTION CRITERIA FOR STUDIES: RCTs in which statins were given for at least 6 months and kidney outcomes were measured. INTERVENTION: Statins versus control, including placebo, usual care, and different types or doses of statins. OUTCOMES: Kidney failure events, rate of change in estimated glomerular filtration rate (eGFR) per year, change in proteinuria or albuminuria, and, in patients with chronic kidney disease, major cardiovascular events. RESULTS: 57 eligible studies with 143,888 participants were included. Statin treatment did not produce an apparent beneficial effect for kidney failure events (OR, 0.98; 95% CI, 0.87-1.10; P=0.7) or end-stage renal disease events (OR, 0.98; 95% CI, 0.90-1.07; P=0.7). However, mean difference for rate of decline in eGFR (0.41 [95% CI, 0.11-0.70] mL/min/1.73m(2) per year slower in statin recipients) and standardized mean difference for change in proteinuria or albuminuria (-0.65 [95% CI, -0.94 to -0.37] standard deviation units, statin recipients vs controls) were statistically significant. In addition, statin therapy significantly reduced the risk for cardiovascular events (OR, 0.69; 95% CI, 0.61-0.79; P<0.001) in patients with chronic kidney disease. LIMITATIONS: Inclusion of several post hoc analyses from large RCTs and substantial heterogeneity in secondary outcome analyses. CONCLUSIONS: Statin therapy does not reduce the risk for kidney failure events in adults not receiving dialysis for whom kidney disease outcomes were reported, but may modestly reduce proteinuria and rate of eGFR decline. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/26905361/Effect_of_Statins_on_Kidney_Disease_Outcomes:_A_Systematic_Review_and_Meta_analysis_ DB - PRIME DP - Unbound Medicine ER -