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Should we use statins in all patients with chronic kidney disease without dialysis therapy? The current state of
Jacek Rysz1, Anna Gluba-Brzózka, Maciej Banach
1Department of Nephrology, Hypertension and Family Medicine, WAM University Hospital of Lodz, Zeromskiego 113, 90-549, Lodz, Poland, jacek.rysz@umed.lodz.pl.
Insights
Statins offer lipid-lowering and anti-proteinuric benefits for chronic kidney disease (CKD) patients. While effective for secondary cardiovascular prevention in mild CKD, their impact on overall mortality in advanced stages remains uncertain.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Dyslipidemia is a significant concern in patients with chronic kidney disease (CKD).
- Effective lipid management is crucial for reducing cardiovascular risk in CKD.
- Current guidelines, such as the 2013 KDIGO recommendations, provide frameworks for lipid management in CKD.
Purpose of the Study:
- To review key aspects of dyslipidemia treatment in CKD patients.
- To present the 2013 KDIGO clinical practice guideline recommendations for lipid management in CKD.
- To synthesize current evidence on the efficacy and safety of lipid-lowering therapies in CKD.
Main Methods:
- Comprehensive literature search of major clinical trials and meta-analyses.
- Systematic review of studies indexed in MEDLINE, EMBASE, Scopus, and DARE databases.
- Inclusion of data presented at national and international cardiovascular meetings.
Main Results:
- Statins demonstrate beneficial effects in CKD patients, including reduced 24-hour urinary protein excretion and potential GFR increase.
- Statins are effective and safe for secondary prevention of cardiovascular events in individuals with mild CKD.
- Treatment with statins led to a decreased incidence of major atherosclerotic events, reduced cardiovascular mortality, and all-cause mortality compared to placebo.
Conclusions:
- Meta-analyses indicate statins provide lipid-lowering, cardiovascular, and anti-proteinuric benefits in CKD.
- The impact of statins on overall and cardiovascular mortality in CKD patients requires further investigation.
- While beneficial for mild renal impairment, statin use in advanced CKD (stages III-V) without prior vascular events remains controversial due to underrepresentation in clinical trials.
Purpose:
The aim of this article was to present the most important matters associated with dyslipidemia treatment in CKD patients. Moreover, the most important recommendations of the current (2013) KDIGO clinical practice guideline for lipid management in chronic kidney disease are presented.
Methods:
Authors looked through the most recent large clinical trials and meta-analyses and presented their results. We searched using the electronic databases [MEDLINE, EMBASE, Scopus, DARE]. Additionally, abstracts from national and international cardiovascular meetings were studied.
Results:
Analysis results suggest that statins exert beneficial effects on kidney since they considerably reduce 24 h urinary protein excretion and are associated with a rise in GFR. Beneficial effects of statins may be influenced by kidney disease stage, doses of medicine and treatment duration. Data suggest that statins are effective and safe for secondary prevention of CV events in individuals with mild CKD. Patients treated with statins had decreased frequency of major atherosclerotic events compared with placebo, reduced risk of CV mortality and deaths from all causes.
Conclusions:
Meta-analyses results suggest that statins are associated with lipid lowering, cardiovascular and anti-proteinuric benefits in CKD patients. However, their effects on overall and cardiovascular mortality are much less obvious. Bearing in mind the advantageous effects and low risk of adverse effects, it seems that mild renal impairment should not exclude these patients from receiving a statin. However, because CKD patients in stages III-V are underrepresented in clinical trials, administration of statins to these patients who have not yet had a vascular event remains controversial.
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