Effects of statins in patients with chronic kidney disease: meta-analysis and meta-regression of randomised controlled trials
Related Experiment Video
Updated: Jul 7, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Giovanni F M Strippoli1, Sankar D Navaneethan, David W Johnson
1NHMRC Centre for Clinical Research Excellence in Renal Medicine, School of Public Health, University of Sydney, Australia.
Insights
Statins effectively lower cholesterol and reduce cardiovascular events in chronic kidney disease patients. However, benefits for all-cause mortality and kidney protection remain unproven, with limited data quality.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Chronic kidney disease (CKD) patients face elevated cardiovascular risks.
- Statins are widely used to manage hyperlipidemia and cardiovascular disease.
- The efficacy and safety of statins in CKD populations require comprehensive analysis.
Purpose of the Study:
- To evaluate the benefits and harms of statin therapy in patients with chronic kidney disease (CKD).
- To analyze statin effects across different stages of CKD: pre-dialysis, dialysis, and transplant recipients.
Main Methods:
- A meta-analysis of randomized and quasi-randomized controlled trials was conducted.
- Data from multiple databases including Cochrane, Medline, Embase, and Renal Health Library were synthesized.
- Treatment effects were summarized using relative risks and weighted mean differences with random effects models.
Main Results:
- Statins significantly reduced total cholesterol, LDL cholesterol, and proteinuria.
- Fatal and non-fatal cardiovascular events were reduced by statins.
- No significant improvement in glomerular filtration rate or all-cause mortality was observed. Statin side effects were comparable to placebo.
Conclusions:
- Statins are beneficial for lipid reduction and cardiovascular event prevention in CKD patients across all stages.
- Evidence for statins improving all-cause mortality or providing direct reno-protective effects in CKD is inconclusive.
- Further high-quality research is needed to clarify the role of statins in primary prevention and their renal benefits in CKD.
Objective:
To analyse the benefits and harms of statins in patients with chronic kidney disease (pre-dialysis, dialysis, and transplant populations).
Design:
Meta-analysis.
Data Sources:
Cochrane Central Register of Controlled Trials, Medline, Embase, and Renal Health Library (July 2006).
Study Selection:
Randomised and quasi-randomised controlled trials of statins compared with placebo or other statins in chronic kidney disease.
Data Extraction And Analysis:
Two reviewers independently assessed trials for inclusion, extracted data, and assessed trial quality. Differences were resolved by consensus. Treatment effects were summarised as relative risks or weighted mean differences with 95% confidence intervals by using a random effects model.
Results:
Fifty trials (30 144 patients) were included. Compared with placebo, statins significantly reduced total cholesterol (42 studies, 6390 patients; weighted mean difference -42.28 mg/dl (1.10 mmol/l), 95% confidence interval -47.25 to -37.32), low density lipoprotein cholesterol (39 studies, 6216 patients; -43.12 mg/dl (1.12 mmol/l), -47.85 to -38.40), and proteinuria (g/24 hours) (6 trials, 311 patients; -0.73 g/24 hour, -0.95 to -0.52) but did not improve glomerular filtration rate (11 studies, 548 patients; 1.48 ml/min (0.02 ml/s), -2.32 to 5.28). Fatal cardiovascular events (43 studies, 23 266 patients; relative risk 0.81, 0.73 to 0.90) and non-fatal cardiovascular events (8 studies, 22 863 patients; 0.78, 0.73 to 0.84) were reduced with statins, but statins had no significant effect on all cause mortality (44 studies, 23 665 patients; 0.92, 0.82 to 1.03). Meta-regression analysis showed that treatment effects did not vary significantly with stage of chronic kidney disease. The side effect profile of statins was similar to that of placebo. Most of the available studies were small and of suboptimal quality; mortality data were provided by a few large trials only.
Conclusion:
Statins significantly reduce lipid concentrations and cardiovascular end points in patients with chronic kidney disease, irrespective of stage of disease, but no benefit on all cause mortality or the role of statins in primary prevention has been established. Reno-protective effects of statins are uncertain because of relatively sparse data and possible outcomes reporting bias.
Related Concept Videos
01:28Chronic Kidney Disease III: Interprofessional Care
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
01:25Chronic Kidney Disease I: Introduction
01:25Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention