Cholesterol-Lowering Treatment in Chronic Kidney Disease: Multistage Pairwise and Network Meta-Analyses

Area of Science:

• Cardiovascular Medicine
• Nephrology
• Pharmacology

Background:

• Chronic kidney disease (CKD) is associated with increased cardiovascular risk.
• Dyslipidemia and inflammation, indicated by elevated low-density lipoprotein cholesterol (LDLc) and C-reactive protein (CRP), are common in CKD patients.
• Effective management of cardiovascular risk factors in CKD is crucial.

Purpose of the Study:

• To evaluate the efficacy of statins, with or without ezetimibe, in reducing cardiovascular events and lipid/inflammatory markers in CKD patients.
• To compare the effectiveness of different statin regimens using pairwise and network meta-analyses.
• To inform individualized treatment strategies for CKD patients.

Main Methods:

• Conducted pairwise and Bayesian network meta-analyses.
• Included studies assessing statins with or without ezetimibe in CKD patients.
• Analyzed outcomes including major adverse cardiovascular events (MACE), LDLc, and CRP levels.

Main Results:

• Pairwise meta-analysis showed statins efficacious in reducing MACE in CKD patients (eGFR < 60 mL/min/1.73 m²).
• Network meta-analysis identified atorvastatin 80 mg and specific equivalent doses of atorvastatin/rosuvastatin as effective in reducing MACE compared to placebo.
• Network analysis also demonstrated reductions in MACE, LDLc, and CRP (all < 50%) in CKD patients, irrespective of eGFR (excluding dialysis patients).

Conclusions:

• Certain statin regimens, notably high-dose atorvastatin, are effective in reducing MACE in CKD patients.
• Cholesterol-lowering therapy targeting both LDLc and CRP may be beneficial for CKD patients.
• Individualized therapeutic approaches are recommended for managing cardiovascular risk in CKD.