Related Experiment Videos
HMG-CoA reductase inhibitors are associated with reduced mortality in ESRD patients
Stephen L Seliger1, Noel S Weiss, Daniel L Gillen
1Division of Nephrology, University of Washington Medical Center, Seattle, Washington, USA.
Insights
Statin use significantly reduces cardiovascular and total mortality in end-stage renal disease (ESRD) patients on dialysis. This finding supports statin therapy for improving survival in this high-risk population.
Area of Science:
- Nephrology
- Cardiology
- Clinical Pharmacology
Background:
- End-stage renal disease (ESRD) patients exhibit elevated cardiovascular disease (CVD) rates.
- Statins (HMG-CoA reductase inhibitors) reduce CVD mortality in non-ESRD populations.
- Underutilization of statins in dialysis patients (10% by 60 days) necessitates outcome evaluation.
Purpose of the Study:
- To investigate the association between statin use and mortality in ESRD patients.
- To determine if statins reduce cardiovascular-specific and total mortality in dialysis patients.
Main Methods:
- Analysis of the U.S. Renal Data System Dialysis Morbidity and Mortality Wave-2 study cohort (n=3716).
- Baseline statin use and characteristics abstracted from dialysis records.
- Cox proportional hazards models used to assess mortality risk, adjusting for known factors.
Main Results:
- Statin users (9.7% at baseline) had lower mortality rates (143/1000 person-years) vs. non-users (202/1000 person-years).
- Statin use independently associated with reduced total mortality (RR=0.68) and cardiovascular mortality (RR=0.64).
- Fibrate use showed no association with reduced mortality (RR=1.29).
Conclusions:
- Statin therapy is linked to decreased cardiovascular-specific death in dialysis patients.
- Statin use is associated with a reduction in overall mortality for ESRD patients on dialysis.
Unlabelled:
BACKGROUND.: Patients with end-stage renal disease (ESRD) suffer from markedly higher rates of cardiovascular disease than the general population. Although therapy with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors ("statins") has been demonstrated to reduce the mortality from cardiovascular disease in patients without ESRD, only 10% of patients on dialysis are treated with these medications by day 60 of ESRD. We determined whether the use of statins is associated with a reduction in cardiovascular-specific death and total mortality in ESRD patients.
Methods:
Data were analyzed from the U.S. Renal Data System Dialysis Morbidity and Mortality Wave-2 study, a cohort of randomly selected patients who were initiating dialysis in 1996. Information about the use of statins as well as other baseline characteristics was abstracted from the patients' dialysis records by dialysis personnel. Cox proportional hazards models were developed to determine the association between use of statins at baseline and subsequent risk of mortality, with adjustment for known mortality risk factors.
Results:
Follow-up data were available for 3716 patients through July 1998. At baseline, 362 (9.7%) of patients were using statins. These patients had a mortality rate of 143/1000 person-years, compared with a rate of 202/1000 person-years for patients not using statins. Statin use was independently associated with a reduced risk of total mortality [relative risk (RR)=0.68, 95% confidence interval (CI)=0.54, 0.87] as well as cardiovascular-specific mortality (RR=0.64, 95% CI=0.45, 0.91). In contrast, the use of fibrates was not associated with reduced mortality (RR=1.29).
Conclusions:
Statin use was associated with a reduction in cardiovascular-specific death and total mortality in patients on dialysis.