Document Detail


Benefits and harms of statin therapy for persons with chronic kidney disease: a systematic review and meta-analysis.
MedLine Citation:
PMID:  22910937     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Statins have uncertain benefits in persons with chronic kidney disease (CKD) because individual trials may have insufficient power to determine whether treatment effects differ with severity of CKD.
PURPOSE: To summarize the benefits and harms of statin therapy for adults with CKD and examine whether effects of statins vary by stage of kidney disease.
DATA SOURCES: Cochrane and EMBASE databases (inception to February 2012).
STUDY SELECTION: Randomized trials comparing the effects of statins with placebo, no treatment, or another statin on mortality and cardiovascular outcomes.
DATA EXTRACTION: Two independent reviewers extracted data and assessed risk of bias.
DATA SYNTHESIS: Eighty trials comprising 51099 participants compared statin with placebo or no treatment. Treatment effects varied with stage of CKD. Moderate- to high-quality evidence indicated that statins reduced all-cause mortality (relative risk [RR], 0.81 [95% CI, 0.74 to 0.88]), cardiovascular mortality (RR, 0.78 [CI, 0.68 to 0.89]), and cardiovascular events (RR, 0.76 [CI, 0.73 to 0.80]) in persons not receiving dialysis. Moderate- to high-quality evidence indicated that statins had little or no effect on all-cause mortality (RR, 0.96 [CI, 0.88 to 1.04]), cardiovascular mortality (RR, 0.94 [CI, 0.82 to 1.07]), or cardiovascular events (RR, 0.95 [CI, 0.87 to 1.03]) in persons receiving dialysis. Effects of statins in kidney transplant recipients were uncertain. Statins had little or no effect on cancer, myalgia, liver function, or withdrawal from treatment, although adverse events were evaluated systematically in fewer than half of the trials.
LIMITATION: There was a reliance on post hoc subgroup data for earlier stages of CKD.
CONCLUSION: Statins decrease mortality and cardiovascular events in persons with early stages of CKD, have little or no effect in persons receiving dialysis, and have uncertain effects in kidney transplant recipients.
Authors:
Suetonia C Palmer; Jonathan C Craig; Sankar D Navaneethan; Marcello Tonelli; Fabio Pellegrini; Giovanni F M Strippoli
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  Annals of internal medicine     Volume:  157     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-08-22     Completed Date:  2012-10-19     Revised Date:  2014-03-27    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  263-75     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Bias (Epidemiology)
Cardiovascular Diseases / mortality,  prevention & control*
Cause of Death
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects*,  therapeutic use*
Kidney Transplantation
Lipids / blood
Renal Dialysis
Renal Insufficiency, Chronic / complications*,  physiopathology,  therapy
Sensitivity and Specificity
Grant Support
ID/Acronym/Agency:
KL2 RR024990/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Lipids
Comments/Corrections
Comment In:
Ann Intern Med. 2012 Nov 20;157(10):JC5-4   [PMID:  23165680 ]
Am J Kidney Dis. 2013 Mar;61(3):371-4   [PMID:  23260277 ]
Evid Based Med. 2013 Oct;18(5):175-6   [PMID:  23268336 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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