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Lifelong statins for long life in dialysis patients?
Thomas Ebert1,2, Peter Bárány1,3
1Karolinska Institutet, Division of Renal Medicine, Department of Clinical Science, Intervention and Technology.
Insights
Statins may offer cardiovascular benefits for dialysis patients by stabilizing risk over time, unlike placebo groups where risk increases. This suggests a potential re-evaluation of statin use in chronic kidney disease (CKD) patients on dialysis.
Area of Science:
- Nephrology
- Cardiology
- Clinical Pharmacology
Background:
- Dyslipidemia is a significant contributor to cardiovascular risk in chronic kidney disease (CKD).
- Statins are recommended for CKD patients over 50 not on dialysis to reduce cardiovascular events.
- Current guidelines do not recommend initiating statins in patients on maintenance dialysis.
Abstract:
Dyslipidemia in chronic kidney disease (CKD) contributes to the increasing cardiovascular risk during progression of the disease. Statins reduces the risk of ischemic cardiovascular events in CKD patients not treated with dialysis and treatment is generally recommended in patients above 50 years old. In CKD patients on maintenance dialysis treatment, it is not recommended to initiate statins based on evidence from randomized clinical trials. In an article by Marx et al. in this issue of CKJ, a post hoc analysis of cardiovascular events in the 4D study of dialysis patients with diabetes mellitus shows different time trends for events in statin-treated patients compared with those in the placebo group. Although the numbers of cardiovascular events were not different, the risk increased over time in the placebo group whereas it stabilized after 1.5 years and remained constant in the atorvastatin group. In this Editorial we discuss this analysis in the context of current guidelines and clinical practice in dialysis patients.
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