Benefits and harms of statin therapy for persons with chronic kidney disease: a systematic review and meta-analysis
Palmer SC, Craig JC, Navaneethan SD, Tonelli M, Pellegrini F, Strippoli GF
Annals of internal medicine · 267 citas
Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación independiente
- Gobierno
- National Center for Research Resources
- Gobierno
- NCRR NIH HHS
- Subvenciones
- National Center for Research Resources (KL2-RR-024990)
Según 2 financiadores declarados.
Publicación
- Publicado
- 2012-08-21 · Ann Intern Med · vol. 157 · número 4 · págs. 263–275
- Editorial
- American College of Physicians
- Citado
- 359 citas · más que el 100% de estudios similares · 49.0× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 119 trabajos
- Acceso
- Acceso abierto (copia en repositorio)
- Áreas de investigación
- Lipoproteins and Cardiovascular Health · Chronic Kidney Disease and Diabetes · Blood Pressure and Hypertension Studies
- Palabras clave
- statins, chronic kidney disease, dialysis, kidney transplant recipients, all-cause mortality, cardiovascular mortality, cardiovascular events, statin adverse effects, cancer risk, myalgia, liver function, treatment withdrawal, CKD stage
- MeSH
- humans, cardiovascular diseases, lipids, hydroxymethylglutaryl-coa reductase inhibitors, renal dialysis, kidney transplantation, cause of death, sensitivity and specificity, renal insufficiency, chronic, bias
6 autores
- Suetonia C. Palmer🇦🇺🇺🇸🇨🇦🇳🇿The University of Sydney; Cleveland Clinic; University of Alberta; University of Otago
- Jonathan C. Craig🇦🇺🇺🇸🇨🇦The University of Sydney; Cleveland Clinic; University of Alberta
- Sankar Dass Navaneethan🇦🇺🇺🇸🇨🇦The University of Sydney; Cleveland Clinic; University of Alberta
- Marcello A. Tonelli🇦🇺🇺🇸🇨🇦The University of Sydney; Cleveland Clinic; University of Alberta
- Fabio Pellegrini🇦🇺🇺🇸🇨🇦🇮🇹The University of Sydney; Cleveland Clinic; University of Alberta; Mario Negri Institute for Pharmacological Research
- Giovanni FM Strippoli🇦🇺🇺🇸🇨🇦🇮🇹The University of Sydney; Cleveland Clinic; University of Alberta; Mario Negri Institute for Pharmacological Research
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background
Statins have uncertain benefits in persons with chronic kidney disease (CKD) because individual trials may have insufficient power to determine whether treatment effects differ with severity of CKD.
Purpose
To summarize the benefits and harms of statin therapy for adults with CKD and examine whether effects of statins vary by stage of kidney disease.
Data sources
Cochrane and EMBASE databases (inception to February 2012).
Study selection
Randomized trials comparing the effects of statins with placebo, no treatment, or another statin on mortality and cardiovascular outcomes.
Data extraction
Two independent reviewers extracted data and assessed risk of bias.
Data synthesis
Eighty trials comprising 51099 participants compared statin with placebo or no treatment. Treatment effects varied with stage of CKD. Moderate- to high-quality evidence indicated that statins reduced all-cause mortality (relative risk [RR], 0.81 [95% CI, 0.74 to 0.88]), cardiovascular mortality (RR, 0.78 [CI, 0.68 to 0.89]), and cardiovascular events (RR, 0.76 [CI, 0.73 to 0.80]) in persons not receiving dialysis. Moderate- to high-quality evidence indicated that statins had little or no effect on all-cause mortality (RR, 0.96 [CI, 0.88 to 1.04]), cardiovascular mortality (RR, 0.94 [CI, 0.82 to 1.07]), or cardiovascular events (RR, 0.95 [CI, 0.87 to 1.03]) in persons receiving dialysis. Effects of statins in kidney transplant recipients were uncertain. Statins had little or no effect on cancer, myalgia, liver function, or withdrawal from treatment, although adverse events were evaluated systematically in fewer than half of the trials.
Limitation
There was a reliance on post hoc subgroup data for earlier stages of CKD.
Conclusion
Statins decrease mortality and cardiovascular events in persons with early stages of CKD, have little or no effect in persons receiving dialysis, and have uncertain effects in kidney transplant recipients.
Resumen vía Europe PMC. Los derechos de autor siguen siendo de los autores o la editorial.
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