Abstract
Dyslipidemia is associated with glomerular injury. However, the effect of statins on chronic kidney disease (CKD) progression remains controversial. We aimed to investigate the efficacy of statins for renal protection in patients with CKD. The retrospective cohort study comprised 3441 patients diagnosed with CKD in multiple medical centers. We divided the patients into two cohorts based on statin prescription, and compared proportions and risks of CKD progression events between the two groups. CKD progression event was defined as an average annual decline of eGFR >5 mL/min/1.73 m2 or advancement to the dialysis stage. The result revealed that among all incident patients with CKD, 28.7% and 30.3% of the users and nonusers demonstrated CKD progression, respectively. The crude odds ratio (OR) of CKD progression was 0.93 [95% confidence interval (CI) 0.78–1.10]. After adjustment for baseline characteristics, the adjusted OR was 0.80 (95% CI 0.63–1.01). The sensitivity analysis results showed consistent OR for CKD progression, stratification by age, sex, Charlson score, and statins use within 1 year before index date. The effect of statins was significant in patients with CKD stage 3B-5 (OR 0.68, 95% CI 0.48–0.95), but not statistically significant in those with CKD stage 1–3A (OR 0.97, 95% CI 0.68–1.38). The effect of statins was significant in patients with proteinuria ≥1000 mg/day (OR 0.63, 95% CI 0.43–0.92), but not statistically significant in those with proteinuria <1000 mg/day (OR 1.02, 95% CI 0.74–1.41).
Highlights
Chronic kidney disease (CKD) is a global health concern[1]
The ALERT trial and Scandinavian Simvastatin Survival Study have demonstrated that statins slowed chronic kidney disease (CKD) progression[14,15]; other studies such as the SHARP study, ALLHAT study, and ASUCA trial have reported that statins exhibit little to no effects on CKD progression[16,17,18]
In contrast to definitions used in previous studies, we identified CKD progression events as either an annual average estimated glomerular filtration rate (eGFR) decline >5 mL/min/1.73 m2 or advancement to the dialysis stage
Summary
Chronic kidney disease (CKD) is a global health concern[1]. According to systemic review data and a meta-analysis of observational studies until September 2014, the global prevalence of CKD was approximately 13.4%, and the prevalence of stage 3–5 CKD was 10.6%1. The Kidney Disease Improving Global Outcomes (KDIGO) lipid management guidelines suggest statin initiation for primary prevention in all patients with CKD above the age of 50 years, and all adult CKD patients with diabetes who are not receiving dialysis[8]. In Taiwan, in adults with eGFR
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