Abstract
Background: For non-dialysis patients with hyperlipidemia, statins may provide clinical benefits in reducing mortality risk; however, the optimal treatment for dialysis patients with hyperlipidemia remains debatable. We evaluated the mortality risks for hyperlipidemic patients with renal disorders associated with statin therapy (ST), using the insurance claims data of Taiwan. Methods: From hyperlipidemic patients diagnosed in 2000–2011, we identified 555,153 patients receiving statin treatment for at least 90 days continuously and 1,141,901 non-statin users, and then randomly selected, from both groups, the propensity score-matched subcohorts of statin users and nonusers in a 1:1 pair by renal function: 415,453 pairs with normal renal function , 43,632 pairs with chronic kidney disease (CKD), and 3,624 pairs with end-stage renal disease (ESRD). We compared the mortalities, by the end of 2016, from all causes, cancer, heart disease, and septicemia between statin users and non-users and between hydrophilic-statin users and lipophilic-statin users. The Cox method estimated ST users to non-user hazard ratios. The time-dependent model was also conducted as sensitivity analysis. Results: The mean ages were 58.7 ± 10.7, 64.2 ± 10.7, and 62.2 ± 10.8 years in normal renal function, CKD, and ESRD groups, respectively. Compared with non-users, statin users had reduced mortality risks from all causes for 32%–38%, from cancer for 37%–46%, from heart disease for 6%–24%, and from septicemia for 17%–21% in all three renal groups. The hydrophilic statin therapy was superior than the lipophilic statin therapy, particularly for reducing deaths from all-causes and cancer. The results under the time-dependent model were similar. Conclusion: Statin therapy is associated with reduced all-causes and non-cardiovascular mortality in ESRD patients.
Highlights
The mortality is higher in dialysis patients than in the general population, approximately 16-fold higher for the US patients and 5fold higher for Japanese patients (De Jager et al, 2009; Wakasugi et al, 2013)
The hydrophilic statin therapy was superior than the lipophilic statin therapy, for reducing deaths from all-causes and cancer
Statin therapy is associated with reduced all-causes and non-cardiovascular mortality in end-stage renal disease (ESRD) patients
Summary
The mortality is higher in dialysis patients than in the general population, approximately 16-fold higher for the US patients and 5fold higher for Japanese patients (De Jager et al, 2009; Wakasugi et al, 2013). The main causes of deaths for patients with end-stage renal disease (ESRD) included cardiovascular disease (CVD), infection, cancer, and dialysis withdrawal (Den Hoedt et al, 2013; Vogelzang et al, 2015; Steenkamp et al, 2018). The UK Renal Registry Annual Report indicated that the deaths from CVD decreased from 34% to 24% in 2000–2015 in adult dialysis patients (Steenkamp et al, 2018). The proportion of non-cardiovascular deaths for ESRD patients was increasing, especially in the elderly group (Den Hoedt et al, 2013; Vogelzang et al, 2015). The study from the ERA-EDTA registry showed an 82-fold increase in infection-related mortality and a near 3-fold increase in cancer-related mortality for dialysis patients compared to the general population (Vogelzang et al, 2015). We evaluated the mortality risks for hyperlipidemic patients with renal disorders associated with statin therapy (ST), using the insurance claims data of Taiwan
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