Do statins delay the incidence of ESRD in diabetic patients with moderate CKD?

There is little information on whether statins and LDL cholesterol are associated with the onset of end-stage renal disease (ESRD) in at-risk populations.

In a retrospective, single-center study of 156 patients with diabetes and CKD, we evaluated disease progression and incidence of ESRD in patients treated or not treated with statins.

There were 81 and 75 patients in statin and no-statin groups respectively. Participants were followed for a median of 28 months (95% CI 19 to 34). Total cholesterol and LDL levels decreased significantly in the statin group and were associated with a significant decrease in the rate of eGFR decline (-6.0 vs. -9.8 mL/min/1.73m(2)/year, p=0.01). However, this difference was not statistically significant after consideration of propensity scores (p=0.43). Kaplan-Meier survival analyses demonstrated that the incidence of ESRD was significantly greater in the no-treatment group (HR=2.21, 95% CI 1.45-3.81, p=0.0007). LDL cholesterol, statins, eGFR, mean arterial pressure and ACE-I/ARB were significant predictors of ESRD in univariate analyses. However, stepwise Cox regression analyses using propensity scores only retained LDL and baseline eGFR as independent predictors of ESRD.

Only LDL cholesterol but not statins were associated with ESRD progression in diabetic patients with moderate CKD after data adjustment for propensity scores. Prospective studies are needed to determine if LDL cholesterol mediates the effect of statins on disease progression in these patients.