Statin use in patients with chronic kidney disease stages 2–4: targeting beyond improved mortality rates

Abstract

The well-designed study by Neves et al. [1] showed that statin and/or vitamin D non-use were independent risk factors of mortality (p = 0.005) in their cohort of patients (n = 95) with chronic kidney disease (CKD) stages 4 and 5 (mean estimated glomerular filtration rate [eGFR] = 16.1 ml/min/1.73 m). After a mean follow-up of 24.1 ± 9.8 months, all patients receiving both statins and vitamin D were alive (18 of 18 patients; 100%). In contrast, only 24 of the 43 patients (56.4%) receiving neither a statin nor vitamin D were alive at the end of the study [1]. Statin use in patients with CKD offers several advantages besides improving mortality rates. Cardiovascular disease (CVD) is the leading cause of death in patients with stages 4 and 5 CKD [2, 3]. Mortality from CVD in this population is approximately 10 to 20 times higher than in the general population [4]. In an analysis of the Pravastatin Pooling Project [5], a subject-level database combining the results from 3 randomized trials of the effects of pravastatin 40 mg/day vs. placebo, the benefit induced by statin use on CVD risk in 19,700 participants with mild/moderate CKD was determined. The 3 randomized studies included in this analysis were the following: the Cholesterol and Recurrent Events (CARE) trial [6], the Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) study [7] and the West of Scotland Coronary Prevention Study (WOSCOPS) [8]. Of the 19,700 total participants in these studies, 12,333 (62.6%) had mild CKD, as defined by an estimated glomerular filtration rate (eGFR) of 60 to 89.9 ml/min/1.73 m and 4,491 (22.8%) had moderate CKD as defined by an eGFR of 30 to 59.9 ml/min/1.73 m. Pravastatin significantly reduced the adjusted incidence of the primary outcome of coronary mortality, non-fatal myocardial infarction and coronary revascularization (hazard ratio [HR], 0.77; 95% confidence interval [CI] 0.68–0.86) and the expanded outcome (cardiovascular mortality, non-fatal myocardial infarction, coronary revascularization or stroke; HR, 0.79; 95% CI 0.71–0.88) in people with moderate CKD [5]. Thus, the effects of statin use in patients with CKD not only include reduction of mortality rates, but also a decrease in CVD events (non-fatal myocardial infarction, stroke and revascularization episodes). K. I. Paraskevas (&) Department of Vascular Surgery, Red Cross Hospital, Athens, Greece e-mail: paraskevask@hotmail.com