Abstract

BackgroundThe effects of statins in patients with diabetic nephropathy are controversial. With increasing interest in the potential therapeutic role of statins in diabetic nephropathy, it is essential to evaluate its real effects.MethodsPubMed, EMBASE, Web of Science databases, Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure were systematically searched for randomized controlled trials (RCTs) of statins in patients with diabetic nephropathy.ResultsFourteen trials with 2866 participants were included in our meta-analysis. Compared with placebo, albuminuria and urinary albumin excretion rates in the statin group were reduced by 0.46 [95 % confidence interval (CI),−0.68 to −0.25, P < 0.0001] and 1.68 (95 % CI, −3.23 to −0.12, P = 0.03), respectively. The reduction of albuminuria was greater in patients of type 2 diabetes mellitus with diabetic nephropathy [standardized mean difference (SMD), −0.56; 95 % CI, −0.80 to −0.32, P < 0.00001] and the decrease was significant during the 1 to 3 years period of statin therapy (SMD, −0.57; 95 % CI, −0.95 to −0.19, P = 0.003). Subgroup analysis demonstrated the effects of statins were much stronger in subjects with pathologic albuminuria: change of −0.71 (95 % CI, −1.09 to −0.33, P = 0.0003) for those with urinary protein excretion 30 to 300 mg/day, −0.37 (95 % CI, −0.67 to −0.06, P = 0.02) for those with excretion more than 300 mg/day and −0.29 (95 % CI, −0.78 to 0.21, P = 0.26) for those with excretion less than 30 mg/day. In contrast, statins did not significantly reduce estimated glomerular filtration rate, serum creatinine and blood urea nitrogen levels.ConclusionsStatins decrease the albuminuria and urinary albumin excretion rates significantly. The efficacy of statins on renal function is time dependent and better in type 2 diabetic patients with nephropathy.

Highlights

  • The effects of statins in patients with diabetic nephropathy are controversial

  • There are growing studies suggested that statins may offer renoprotective effects and beneficial effect on pathologic albuminuria and decrease the reduction of estimated glomerular filtration rate [6,7,8]

  • Clinical trials were included if the following criterias were met: (1) Primary study of statins versus control; (2) Diabetic nephropathy patients with type 1 and type 2 diabetes mellitus at least 18 years old without pregnancy; (3) Patients with diabetic nephropathy in experimental group were defined as those who used statins, regardless of dosages, mode of administration or treatment duration; (4) randomized controlled trials (RCTs) design; (5) Report of baseline and the end of follow-up data on renal function [estimated glomerular filtration rate, urinary albumin excretion rates (UAER), serum creatinine (Scr), blood urea nitrogen (BUN) or albuminuria)

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Summary

Introduction

The effects of statins in patients with diabetic nephropathy are controversial. With increasing interest in the potential therapeutic role of statins in diabetic nephropathy, it is essential to evaluate its real effects. According to the International Diabetes Federation [1], it is projected that the number of people with diabetes worldwide will increase from 382 million in 2013 to 592 million by 2035. Diabetic nephropathy (DN) is one of the most common and serious chronic complication of diabetes and it is the leading cause of end-stage renal disease [2]. A number of potential mechanisms for kidney damage in DN have been identified. 3hydroxy-3 methylglutaryl coenzyme A (HMG CoA) reductase inhibitor, is a kind of antihyperlipidemic drug that used worldwide for its strong low-density lipoprotein cholesterol (LDL-C)-lowering effects and established. Some trials [9, 10] failed to demonstrate that statin improve eGFR

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