Abstract
Previous studies showed that statins reduce the progression of kidney function decline and proteinuria, but whether specific types of statins are more beneficial than others remains unclear. We performed a network meta-analysis of randomized controlled trials (RCT) to investigate which statin most effectively reduces kidney function decline and proteinuria. We searched MEDLINE, Embase, Web of Science, and the Cochrane database until July 13, 2018, and included 43 RCTs (>110,000 patients). We performed a pairwise random-effects meta-analysis and a network meta-analysis according to a frequentist approach. We assessed network inconsistency, publication bias, and estimated for each statin the probability of being the best treatment. Considerable heterogeneity was present among the included studies. In pairwise meta-analyses, 1-year use of statins versus control reduced kidney function decline by 0.61 (95%-CI: 0.27; 0.95) mL/min/1.73 m2 and proteinuria with a standardized mean difference of −0.58 (95%-CI:−0.88; −0.29). The network meta-analysis for the separate endpoints showed broad confidence intervals due to the small number available RCTs for each individual comparison. In conclusion, 1-year statin use versus control attenuated the progression of kidney function decline and proteinuria. Due to the imprecision of individual comparisons, results were inconclusive as to which statin performs best with regard to renal outcome.
Highlights
Previous studies showed that statins reduce the progression of kidney function decline and proteinuria, but whether specific types of statins are more beneficial than others remains unclear
Since only a small number of randomized controlled trials (RCT) with small sample sizes studied the effect of statins on proteinuria, we could not perform the aforementioned sensitivity analyses. In this network meta-analysis, we showed that there are no substantial differences in the efficacy of seven different statins and dosages, with or without ezetimibe, regarding slowing down estimated glomerular filtration rate (eGFR) decline or reducing proteinuria
In the pairwise meta-analysis we showed that use of statins lowered the rate of annual kidney function decline by 0.61 mL/min/1.73 m2 and reduced the amount of proteinuria by −0.58 (95%-CI −0.88; −0.29) standard deviations per year
Summary
Previous studies showed that statins reduce the progression of kidney function decline and proteinuria, but whether specific types of statins are more beneficial than others remains unclear. We performed a network meta-analysis of randomized controlled trials (RCT) to investigate which statin most effectively reduces kidney function decline and proteinuria. In pairwise meta-analyses, 1-year use of statins versus control reduced kidney function decline by 0.61 (95%-CI: 0.27; 0.95) mL/min/1.73 m2 and proteinuria with a standardized mean difference of −0.58 (95%-CI:−0.88; −0.29). We performed a network meta-analysis of randomized controlled trials in adults that compare any statin with another statin or control treatment, to investigate which statin most effectively reduces kidney function decline or proteinuria. Network meta-analyses take into account www.nature.com/scientificreports both direct and indirect evidence of multiple comparisons in a treatment network, and provide information on which treatment performs best These results may inform future guidelines about prevention of CKD and slowing down its progression
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