Statins reduce total cholesterol and triglycerides in dialysis patients to a level similar to that seen in the general population

Navaneethan SD, Nigwekar SU, Perkovic V, Johnson DW, Craig JC, Strippoli GFM

Published Online:

July 8, 2009

Dialysis patients are at high risk of heart disease. Statins have been shown to decrease cholesterol levels and mortality in the general population. We aimed to determine if a similar effect has been established in dialysis patients. This review identified 14 studies - 13 comparing statins with placebo and one comparing statins to another lipid lowering agent. Statins decreased cholesterol levels to a level similar to that seen in the general population and were safe. One large study did not find any major mortality benefits with statins even though it reduced the number of cardiovascular events in dialysis patients.

Abstract (click to read)

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.

This record should be cited as:

Navaneethan SD, Nigwekar SU, Perkovic V, Johnson DW, Craig JC, Strippoli GFM. HMG CoA reductase inhibitors (statins) for dialysis patients. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD004289. DOI: 10.1002/14651858.CD004289.pub4

Assessed as up to date:

July 21, 2008

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Primary Review Group:

Renal Group

Health topics:

Kidney disease > End-stage kidney disease > Peritoneal dialysis

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Statins reduce total cholesterol and triglycerides in dialysis patients to a level similar to that seen in the general population

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