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Lipid-lowering therapy in persons with chronic kidney disease: a systematic review and meta-analysis
Ashish Upadhyay1, Amy Earley, Jenny L Lamont
1Renal Section, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 72 East Concord Street, Evans 124, Boston, MA 02118, USA. ashishu@bu.edu
Insights
Lipid-lowering therapy significantly reduces cardiac mortality and cardiovascular events in chronic kidney disease (CKD) patients. However, it does not improve kidney outcomes, with similar adverse events across groups.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Chronic kidney disease (CKD) patients face high risks of dyslipidemia and cardiovascular disease.
- Lipid-lowering therapy is underutilized in this population despite these risks.
Purpose of the Study:
- To synthesize evidence on the impact of lipid-lowering therapy on clinical outcomes in individuals with CKD.
- To evaluate the efficacy and safety of lipid-lowering treatments in CKD patients.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) published between 2000 and 2011.
- Included RCTs comparing lipid-lowering therapy with control in CKD populations and CKD subgroups from general population trials.
- Data extraction focused on methodology, population, interventions, cardiovascular and kidney outcomes, and adverse events; random-effects model meta-analyses were performed.
Main Results:
- Lipid-lowering therapy, primarily statins and statin-ezetimibe combinations, did not improve kidney outcomes.
- Significant reductions were observed in cardiac mortality (RR, 0.82), cardiovascular events (RR, 0.78), and myocardial infarction (RR, 0.74).
- All-cause mortality showed a benefit, though limited by heterogeneity; adverse events were comparable between groups.
Conclusions:
- Lipid-lowering therapy effectively decreases cardiac death and atherosclerosis-related cardiovascular events in individuals with CKD.
- Further research is needed due to data limitations in children and study heterogeneity.
- Potential for selective reporting of outcomes and adverse events requires consideration.
Background:
Lipid-lowering therapy is not widely used in persons with chronic kidney disease (CKD) despite a high burden of dyslipidemia and cardiovascular disease in this population.
Purpose:
To synthesize evidence examining the effect of lipid-lowering therapy on clinical outcomes in persons with CKD.
Data Sources:
MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from January 2000 through November 2011.
Study Selection:
Randomized, controlled trials (RCTs) comparing lipid-lowering therapy with control treatment in persons with CKD, including subgroup analyses of trials in the general population.
Data Extraction:
Abstracts were screened and data were extracted on study methodology, population, interventions, cardiovascular and kidney outcomes, and adverse events. Data were extracted by one author and confirmed by another. Study quality was determined by consensus. Random-effects model meta-analyses were performed.
Data Synthesis:
18 RCTs, all in adults, met the eligibility criteria. Five RCTs involved CKD populations, and 13 were CKD subgroup analyses from trials in the general population. Sixteen RCTs examined statins, and 2 examined statins plus ezetimibe. Lipid-lowering therapy does not improve kidney outcomes but decreases the risk for cardiac mortality (pooled risk ratio [RR] from 6 trials, 0.82 [95% CI, 0.74 to 0.91]; P< 0.001), cardiovascular events (including revascularization) (pooled RR from 9 trials, 0.78 [CI, 0.71 to 0.86]; P< 0.001), and myocardial infarction (pooled RR from 9 trials, 0.74 [CI, 0.67 to 0.81]; P< 0.001). Significant benefit was also seen for all-cause mortality but was limited by a high degree of heterogeneity. No benefit was found for other cardiovascular outcomes. Rates of adverse events were similar between intervention and comparator groups.
Limitations:
Lack of data in children, heterogeneity among reviewed studies, and the possibility of selective reporting of outcomes and adverse events.
Conclusion:
Lipid-lowering therapy decreases cardiac death and atherosclerosis-mediated cardiovascular events in persons with CKD.
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