Effects of statins on lipid profile in chronic kidney disease patients: a meta-analysis of randomized controlled trials

Abstract

Objective:

The available data on statin effects in chronic kidney disease (CKD) patients are still conflicting. We investigated the impact of short- and long-term statin therapy on lipid profiles in CKD patients requiring or not requiring dialysis.

Research design and methods:

Data from Scopus, PubMed, Web of Science, and the Cochrane Library from 1966 to May 2012 were searched for studies that investigated this effect. We included all randomized controlled clinical trials that investigated the impact of statin therapy on lipids and lipoproteins.

Results:

The final analysis included 16 trials with 3594 subjects. In CKD patients, statin therapy significantly reduced total cholesterol (TC), triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) (p < 0.003 for all comparisons), and the effect insignificantly intensified with duration of statin therapy (56.3 vs 66.8, 22.5 vs 24.1, and 53 vs 56.1 mg/dl, respectively). Comparing statin therapy for ≤3 and >3 months in CKD patients on dialysis, the magnitude of TC and LDL-C decreased (26.3 vs 25.9, and 42.2 vs 29.8 mg/dl, respectively, p > 0.05 for both), while TG increased modestly (4.5 vs 13.4 mg/dl). Short-term statin therapy increased high density lipoprotein cholesterol by a mean 0.7 mg/dl (p = 0.04), and long-term therapy was associated with a mean reduction of 2.4 mg/dL.

Conclusions:

Statin therapy significantly modifies the lipid profile in CKD patients not on dialysis therapy (with the trend to be more effective with longer therapy), and have less beneficial effect in patients on dialysis with the trend to be less effective with longer duration of therapy.

Keywords::

• Cholesterol
• Chronic kidney disease
• Dialysis
• Hemodialysis
• Lipids
• Lipoproteins
• Meta-analysis
• Statins

Transparency

Declaration of funding

This meta-analysis was written independently; no company or institution supported it financially. No professional writer was involved in the preparation of this meta-analysis.

Declaration of financial/other relationships

DG, SN, PS, JR, MA have no conflict of interest. MR has given talks and participated in conferences sponsored by Astra-Zeneca, Bracco, Bromatech, Chiesi Farmaceutici, Novartis, Novo-Nordisk, Rikrea and Servier. KKR has received honoraria for lectures or advisory boards from Pfizer, Astra-Zeneca, MSD, Roche, Novartis, Sanofi, Regeneron, Servier, Lilly, Daiichi Sankyo, Kowa, Novo-Nordisk, Abbott, Bayer. MJP is a member of DSMB for AbbVie. DPM has given talks, attended conferences and participated in trials and advisory boards sponsored by MSD, Genzyme and Abbott. PPT has given talks for AbbVie, Amarin, Astra-Zeneca, Genzyme, Kowa, Merck and is consultant for Amgen, Atherotech, Genzyme, Kowa, Liposcience, Merck. SJN has received research support from AstraZeneca, Eli Lilly, Novartis, Anthera, Resverlogix, Roche and Amgen, and is a consultant for AstraZeneca, Merck, Roche, Takeda, CSL Behring, Omthera, Amgen, Boehringer Ingelheim and Kowa. MB has given talks, attended conferences and has received research support from MSD, Abbott, AstraZeneca, Roche, Synageva, Polfarmex and Amgen.

Acknowledgments

This work is part of collaboration between the BioMedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy; Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Iran; Food and Drug Laboratory Research Center, Ministry of Health and Medical Education, Tehran, Iran; Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Euro-Mediterranean Institute of Science and Technology, Italy; Cardiovascular Sciences Research Centre, St George’s University of London, UK; Department of Biostatistics, Boston University, Harvard Clinical Research Institute, Boston, MA, USA; Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London; University of Illinois College of Medicine, Peoria, IL, USA; South Australian Health & Medical Research Institute, University of Adelaide, Australia; Department of Hypertension, Medical University of Lodz, Poland and Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran.