HMG CoA reductase inhibitors (statins) for dialysis patients

Navaneethan, Sankar D., Nigwekar, Sagar U., Perkovic, Vlado, Johnson, David W., Craig, Jonathan C. and Strippoli, Giovanni F. M. (2004) HMG CoA reductase inhibitors (statins) for dialysis patients. Cochrane Database of Systematic Reviews, 2: 1-59. doi:10.1002/14651858.CD004289.pub2

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Author Navaneethan, Sankar D.
Nigwekar, Sagar U.
Perkovic, Vlado
Johnson, David W.
Craig, Jonathan C.
Strippoli, Giovanni F. M.
Title HMG CoA reductase inhibitors (statins) for dialysis patients
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2004-01-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD004289.pub2
Open Access Status File (Publisher version)
Issue 2
Start page 1
End page 59
Total pages 59
Place of publication United Kingdom
Publisher John Wiley & Sons
Language eng
Subject 110312 Nephrology and Urology
11 Medical and Health Sciences
1103 Clinical Sciences
Formatted abstract
Background
Cardiovascular disease accounts for more than half the number of deaths among dialysis patients. The role of HMG CoA reductase inhibitors (statins) in the treatment of dyslipidaemia in dialysis patients is unclear and their safety has not been established.

Objectives
To assess the benefits and harms of statins in peritoneal dialysis (PD) and haemodialysis patients (HD).

Search strategy
We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled trials (CENTRAL, in The Cochrane Library), the Cochrane Renal Group's specialised register and handsearched reference lists of textbooks, articles and scientific proceedings.

Selection criteria
Randomised controlled trials (RCTs) and quasi-RCTs comparing statins with placebo, no treatment or other hypolipidaemic agents in dialysis patients.

Data collection and analysis
Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model after testing for heterogeneity. The results were expressed as mean difference (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI).

Main results
Fourteen studies (2086 patients) compared statins versus placebo or other lipid lowering agents. Compared to placebo, statins did not decrease all-cause mortality (10 studies, 1884 patients; RR 0.95, 95% CI 0.86 to 1.06) or cardiovascular mortality (9 studies, 1839 patients: RR 0.96, 95% CI 0.65 to 1.40). There was a lower incidence of nonfatal cardiovascular events with statins compared to placebo in haemodialysis patients (1 study, 1255 patients; RR 0.86, 95% CI 0.74 to 0.99). Compared with placebo, statin use was associated with a significantly lower end of treatment average total cholesterol (14 studies, 1823 patients; MD -42.61 mg/dL, 95% CI -53.38 to -31.84), LDL cholesterol (13 studies, 1801 patients; MD -43.06 mg/dL, 95% CI -53.78 to -32.35) and triglycerides (14 studies, 1823 patients: MD -24.01 mg/dL, 95% CI -47.29 to -0.72). There was similar occurrence of rhabdomyolysis and elevated liver function tests with statins in comparison to placebo.

Authors' conclusions
Statins decreased cholesterol levels in dialysis patients similar to that of the general population. With the exception of one study, studies were of short duration and therefore the efficacy of statins in decreasing the mortality rate is still unclear. Statins appear to be safe in this high-risk population. Ongoing studies should provide more insight about the efficacy of statins in reducing mortality rates in dialysis patients.
Keyword Antilipemic Agents
Cholesterol
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Peritoneal Dialysis, Continuous Ambulatory
Randomized Controlled Trials as Topic
Renal Dialysis; Triglycerides
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown
Additional Notes Article Number: CD004289. Version 2 published online: 18 Oct 2004.

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
 
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Created: Sat, 04 Jul 2009, 01:19:59 EST by Maria Campbell on behalf of Faculty Of Health Sciences