Meta-analysis of statin therapy in maintenance dialysis patients

Figures & data

Figure 1. Flowchart showing the study selection process.

Table 1. Characteristics, baseline and outcomes of included studies in the meta-analysis.

						LDL-C (mmol/L)		TG (mmol/L)		HDL-C (mmol/L)		hs-CRP (mg/L)		ALB (g/L)
Study [references]	Year	Population	No. of patients	Intervention	Follow-up (mo)	Before	After	Before	After	Before	After	Before	After	Before	After	All cardiac events	Cardiovascular deaths	All-cause mortality
4D8	2005	MHD	619	Atorvastatin 20 mg/d	48	3.23 ± 0.75	1.87 ± 0.44	2.95 ± 1.86	NA	0.93 ± 0.34	NA	5.00	4.40	NA	NA	205 (33)	121 (20)	297 (48)
			636	Placebo	48	3.28 ± 0.78	3.21 ± 0.76	3.01 ± 1.91	NA	0.93 ± 0.36	NA	5.00	6.00	NA	NA	246 (39)	149 (23)	320 (50)
AURORA9	2009	MHD	1389	Rosuvastatin 10 mg/day	48	2.59 ± 0.91	1.5 ± 0.39	1.77 ± 1.07	1.48 ± 0.8	1.16 ± 0.39	1.19 ± 0.41	4.8 (2.0–13.6)	4.3	NA	NA	434 (31)	324 (23)	636 (46)
			1384	Placebo	48	2.56 ± 0.88	2.51 ± 0.85	1.74 ± 1.1	1.75 ± 0.81	1.16 ± 0.41	1.17±0.41	5.2 (2.1–14.4)	5.9	NA	NA	468 (34)	324 (23)	660 (48)
Doh27	2012	PD	31	Rosuvastatin 10 mg/day	6	3.05 ± 0.74	1.78 ± 0.56	1.08 (0.81–1.72)	1.03 (0.71–1.52)	1.37 ± 0.39	1.29 ± 0.41	2.05 ± 1.57	1.21 ± 0.84	NA	NA	NA	NA	NA
			30	Placebo	6	3.00 ± 0.96	3.16 ± 0.99	1.21 (0.95–1.89)	1.28 (0.92–1.68)	1.37 ± 0.47	1.27 ± 0.43	1.90 ± 1.33	1.85 ± 1.14	NA	NA	NA	NA	NA
Kishimoto26	2010	MHD	14	Simvastatin 10 mg/day	4	2.83 ± 0.87	1.93 ± 0.79	1.51 ± 0.7	1.16 ± 0.5	0.83 ± 0.16	0.93 ± 0.24	NA	NA	NA	NA	NA	NA	NA
			14	Simvastatin 5 mg/day	4	2.15 ± 0.89	1.67 ± 0.73	1.13 ± 0.65	1.14 ± 0.55	0.84 ± 0.3	0.91 ± 0.35	NA	NA	NA	NA	NA	NA	NA
			9	Placebo	4	2.42 ± 0.81	2.46 ± 0.85	1.22 ± 0.46	1.3 ± 0.61	0.86 ± 0.2	0.87 ± 0.23	NA	NA	NA	NA	NA	NA	NA
Diepeveen25	2005	MHD, PD	13	Atorvastatin 40 mg/day	3	2.6 ± 0.9	1.3 ± 0.8	3.8 ± 3.3	2.4 ± 1.9	0.97 ± 0.3	0.94 ± 0.3	NA	NA	NA	NA	NA	NA	NA
			10	Placebo	3	2.7 ± 0.8	3.0 ± 0.8	2.6 ± 1.7	2.3 ± 1.2	0.92 ± 0.3	0.92 ± 0.3	NA	NA	NA	NA	NA	NA	NA
SHARP7	2011	MHD, PD	1533	Simvastatin 20 mg/day  + ezetimibe 10 mg/day	60	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	230(15)	172(11)	507(33)
			1490	Placebo	60	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	246(17)	161(11)	480(32)
Cui12	2011	CAPD	30	Simvastatin 20 mg/d	6	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	5(18)	NA	NA
			30	Placebo	6	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	8(27)	NA	NA
He21	2009	MHD	30	Simvastatin 40 mg/day	4.5	NA	NA	NA	NA	NA	NA	19.43 ± 12.01	10.09 ± 6.09	33.20 ± 4.50	37.90 ± 5.50	NA	NA	NA
			30	Placebo	4.5	NA	NA	NA	NA	NA	NA	18.6 ± 9.40	14.07 ±8.28	32.60 ± 6.07	36.07 ± 5.30	NA	NA	NA
He JF10	2012	CAPD	30	Atorvastatin 20 mg/day	6	2.71 ± 0.80	1.91±0.78	NA	NA	NA	NA	1.23 ± 0.62	0.73 ± 0.66	NA	NA	NA	NA	NA
			30	Placebo	6	2.72 ± 0.79	2.72 ± 0.79	NA	NA	NA	NA	1.22 ± 0.65	1.21 ± 0.65	NA	NA	NA	NA	NA
Hu24	2011	MHD	34	Simvastatin 20 mg/day	3	NA	NA	NA	NA	NA	NA	3.9±1.5	3.2 ± 1.0	NA	NA	NA	NA	NA
			34	Placebo	3	NA	NA	NA	NA	NA	NA	4.2 ± 1.9	4.4 ± 1.7	NA	NA	NA	NA	NA
Jin20	2005	MHD	30	Simvastatin 20 mg/d	3	4.4 ± 1.3	3.8 ± 0.6	3.0 ± 0.8	2.8 ± 0.7	1.3 ± 0.5	1.9 ± 0.6	10 ± 1.3	4.8 ± 0.9	30 ± 10	34 ± 11	NA	NA	NA
			21	Placebo	3	4.2 ± 1.2	4.0 ± 1.0	2.8 ± 1.1	2.9 ± 1.2	1.3 ± 0.7	1.2 ± 0.6	9.6 ± 1.0	9.3 ± 1.1	31 ± 8.9	30.5 ± 12	NA	NA	NA
Li13	2013	MHD	50	Atorvastatin 20 mg/day	6	2.8 ± 1.6	2.4 ± 1.4	1.5 ± 0.5	1.1 ± 0.5	0.9 ± 0.3	1.0 ± ± 0.5	NA	NA	31.8 ± 9.2	32.8 ± 7.6	7(14)	NA	NA
			50	Placebo	6	2.7 ± 1.7	2.5 ± 1.5	1.4 ± 0.6	1.3 ± 0.7	1.0 ± 0.4	0.9 ± 0.3	NA	NA	32.6 ± 10.5	31.6 ± 9.7	11(22)	NA	NA
Li15	2009	MHD	30	Atorvastatin 20 mg/day	3	3.34 ± 0.18	2.71 ± ± 0.18	2.30 ± 0.55	1.18±0.29	NA	NA	5.13 ± 1.43	2.11 ± 0.53	35.00 ± 4.70	36.80 ± 5.60	NA	NA	NA
			35	Placebo	3	3.41 ± 0.20	3.02 ± 0.15	2.27 ± 0.45	1.64 ± 0.42	NA	NA	5.54 ± 1.04	3.18 ± 0.60	35.10 ± 7.10	36.10 ± 5.10	NA	NA	NA
Pan16	2008	MHD	30	Fluvastatin 20 mg/day	3	4.3 ± 1.2	3.5 ± 0.8	3.1 ± 0.7	2.7 ± 0.8	1.2 ± 0.3	1.9 ± 0.4	10.9 ± 1.4	4.5 ± 1.1	29 ± 10	34 ± 11	NA	NA	NA
			20	Placebo	3	4.2 ± 1.2	4.3 ± 1.1	3.0 ± 0.8	2.9 ± 0.9	1.3 ± 0.4	1.2 ± 0.5	9.9 ± 1.3	9.6 ± 1.2	30 ± 9	29 ± 11	NA	NA	NA
Yang11	2006	MHD	22	Pravastatin 20 mg/day	6.25	3.16 ± 0.23	2.72 ± 0.30	1.13 ± 0.82	0.85 ± 1.50	1.05 ± 0.09	1.51 ± 0.17	11.27 ± 2.3	3.8 ± 1.84	NA	NA	NA	NA	NA
			22	Placebo	6.25	2.96 ± 0.30	3.05 ± 0.20	1.00 ± 0.14	1.10 ± 0.50	1.46 ± 0.14	1.36 ± 0.89	11.62 ± 1.96	11.62 ± 1.84	NA	NA	NA	NA	NA
Yao14	2011	MHD	18	Atorvastatin 20 mg/day	6	NA	NA	NA	NA	NA	NA	16.3 ± 2.9	5.7 ± 2.4	NA	NA	NA	NA	NA
			18	Placebo	6	NA	NA	NA	NA	NA	NA	17.8 ± 3.4	15.9 ± 3.3	NA	NA	NA	NA	NA
Zhang17	2010	MHD	28	Fluvastatin 20 mg/day	6	3.17 ± 0.78	2.72 ± 0.37	1.78 ± 0.54	1.36 ± 0.45	1.18 ± 0.50	1.59 ± 0.53	5.23 ± 1.25	3.19 ± 0.85	NA	NA	NA	NA	NA
			28	Placebo	6	3.19 ± 0.62	3.14 ± 0.57	1.82 ± 0.61	1.76 ± 0.55	1.21 ± 0.58	1.24 ± 0.55	5.17 ± 1.48	5.08 ± 1.36	NA	NA	NA	NA	NA
Zhang22	2011	MHD	40	Simvastatin 20 mg/day	6	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
			40	Placebo	6	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Zhang23	2011	MHD	32	Simvastatin 40 mg/day	6	3.23 ± 0.81	2.68 ± 0.35	1.89 ± 0.51	1.38 ± 0.52	1.19 ± 0.52	1.61 ± 0.5	8.27 ± 1.62	5.34±3.85	NA	NA	NA	NA	NA
			32	Placebo	6	3.24 ± 0.67	3.12 ± 0.56	1.84 ± 0.63	1.81 ± 0.58	1.25 ± 0.55	1.29 ± 0.58	8.48 ± 1.38	7.83 ± 1.36	NA	NA	NA	NA	NA
Zheng18	2007	MHD	24	Fluvastatin 40 mg/day	3	4.6 ± 1.4	3.7 ± 0.8	3.2 ± 0.8	2.7 ± 0.7	1.4 ± 0.6	2.0 ± 0.8	11.0 ± 2.4	4.3 ± 1.2	29.0 ± 10	34.0 ± 12	NA	NA	NA
			20	Placebo	3	4.5 ± 1.2	4.4 ± 1.1	3.0 ± 1.2	2.9 ± 1.2	1.4 ± 0.7	1.3 ± 0.8	9.9 ± 1.3	9.6 ± 1.2	30.0 ± 9.7	30.3 ± 11	NA	NA	NA
Zheng19	2012	MHD	79	Simvastatin 20 mg/d	3	NA	NA	NA	NA	NA	NA	11.23 ± 6.95	3.41 ± 2.24	NA	NA	NA	NA	NA
			79	Placebo	3	NA	NA	NA	NA	NA	NA	11.12 ± 6.75	11.98 ± 6.89	NA	NA	NA	NA	NA

Notes: MHD, maintenance hemodialysis; PD, peritoneal dialysis; CAPD, continuous ambulatory peritoneal dialysis; LDL-C, low density lipoprotein-cholesterol; HDL-C, high density lipoprotein-cholesterol; TG, triglyceride; hs-CRP, high-sensitivity C-reactive protein; ALB, albumin; NA, not specified or available.

Table 2. Risk of bias for included studies.

Study [references]	Random Sequence generation	Allocation concealment	Double blinding	Incomplete outcome data	Selective reporting	Other bias
4D8	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
AURORA9	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
Doh27	Low risk	Low risk	Unclear	Low risk	Low risk	Low risk
Kishimoto26	Low risk	Low risk	Unclear	Low risk	Low risk	Low risk
Diepeveen25	Low risk	Low risk	Unclear	Low risk	Low risk	Low risk
SHARP7	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
Cui12	Unclear	Unclear	Unclear	Low risk	Low risk	Low risk
He21	Unclear	Unclear	Unclear	Low risk	Low risk	Low risk
He10	Unclear	Unclear	Unclear	Low risk	Low risk	Low risk
HU24	Unclear	Unclear	Unclear	Low risk	Low risk	Low risk
Jin20	Unclear	Unclear	Unclear	Low risk	Low risk	Low risk
Li13	Unclear	Unclear	Unclear	Low risk	Low risk	Low risk
Li15	Unclear	Unclear	Unclear	Low risk	Low risk	Low risk
Pan16	Unclear	Unclear	Unclear	Low risk	Low risk	Low risk
Yang11	Unclear	Unclear	Unclear	Low risk	Low risk	Low risk
Yao14	Unclear	Unclear	Unclear	Low risk	Low risk	Low risk
Zhang17	Unclear	Unclear	Unclear	Low risk	Low risk	Low risk
Zhang22	Unclear	Unclear	Unclear	Low risk	Low risk	Low risk
Zhang23	Unclear	Unclear	Unclear	Low risk	Low risk	Low risk
Zheng18	Unclear	Unclear	Unclear	Low risk	Low risk	Low risk
Zheng19	Unclear	Unclear	Unclear	Low risk	Low risk	Low risk

Figure 2. Forest plot of comparison for LDL-C: statin therapy versus placebo.

Figure 3. Forest plot of comparison for TG: statin therapy versus placebo.

Figure 4. Forest plot of comparison for HDL-C: statin therapy versus placebo.

Figure 5. Forest plot of comparison for hs-CRP: statin therapy versus placebo.

Figure 6. Forest plot of comparison for ALB: statin therapy versus placebo.

Figure 7. Forest plot of comparison for all cardiac events: statin therapy versus placebo.

Figure 8. Forest plot of comparison for cardiovascular deaths: statin therapy versus placebo.

Figure 9. Forest plot of comparison for all-cause mortality: statin therapy versus placebo.

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