Saltissi David, Westhuyzen Justin, Morgan Colleen, Healy Helen
Department of Renal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Clin Exp Nephrol. 2006 Sep;10(3):201-9. doi: 10.1007/s10157-006-0425-8.
Patients with dyslipidemia and advanced renal failure are at markedly increased risk of cardiovascular morbidity and mortality. We evaluated the efficacy, safety, and tolerability of atorvastatin in non-nephrotic, dyslipidemic patients with chronic renal failure (CRF) or endstage renal failure (ESRF) receiving dialysis.
Following a 6-week baseline period, adult patients meeting Australian Heart Foundation treatment guidelines received atorvastatin for 16 weeks: 19 with CRF (predialysis), 17 on hemodialysis (HD), and 13 on continuous ambulatory peritoneal dialysis (CAPD). Dose (10-40 mg daily) was titrated to achieve lipid-lowering targets. Efficacy was determined by monitoring lipids (principally triglycerides and low-density lipoprotein [LDL] cholesterol); safety and tolerance by monitoring clinical and laboratory parameters.
Atorvastatin was effective in reducing LDL cholesterol from baseline at each of weeks 4, 8, 12, and 16 in all study groups, with reductions of more than 40% at week 16. Sixty-two percent of PD, 73% of HD, and 100% of CRF patients were at or below target (<2.6 mmol/l) for LDL cholesterol at week 16. Significant reductions in triglycerides (approximately 27%) were seen in the CRF and combined HD/CAPD groups at all time points. Depending on the group, 65%-83% of patients were at or below target (<2.0 mmol/l) for triglycerides at week 16. The majority of patients received the 10-mg dose. Atorvastatin also reduced total cholesterol and apolipoprotein B levels in all groups and very-low-density lipoprotein (VLDL) cholesterol in the CRF group. Significant increases in LDL particle size were found in the HD and combined HD/CAPD groups. Minor, particularly gastrointestinal, symptoms were common. Three patients reported musculoskeletal symptoms, but creatine kinase was raised in only one.
Atorvastatin is an effective lipid-lowering agent for dyslipidemic subjects with advanced and endstage renal failure, and was reasonably well tolerated.
血脂异常和晚期肾衰竭患者发生心血管疾病的发病率和死亡率显著增加。我们评估了阿托伐他汀在接受透析的非肾病性血脂异常慢性肾衰竭（CRF）或终末期肾衰竭（ESRF）患者中的疗效、安全性和耐受性。
在为期6周的基线期后，符合澳大利亚心脏基金会治疗指南的成年患者接受阿托伐他汀治疗16周：19例CRF（透析前）患者、17例血液透析（HD）患者和13例持续性非卧床腹膜透析（CAPD）患者。调整剂量（每日10 - 40毫克）以实现降脂目标。通过监测血脂（主要是甘油三酯和低密度脂蛋白[LDL]胆固醇）来确定疗效；通过监测临床和实验室参数来评估安全性和耐受性。
在所有研究组中，阿托伐他汀在第4、8、12和16周时均能有效降低LDL胆固醇水平，较基线水平降低超过40%。在第16周时，62%的PD患者、73%的HD患者和100%的CRF患者的LDL胆固醇水平达到或低于目标值（<2.6毫摩尔/升）。在CRF组以及HD/CAPD联合组的所有时间点，甘油三酯水平均显著降低（约27%）。在第16周时，根据分组情况，65% - 83%的患者甘油三酯水平达到或低于目标值（<2.0毫摩尔/升）。大多数患者接受10毫克剂量的药物治疗。阿托伐他汀还降低了所有组的总胆固醇和载脂蛋白B水平，以及CRF组的极低密度脂蛋白（VLDL）胆固醇水平。在HD组和HD/CAPD联合组中，LDL颗粒大小显著增加。轻微症状，尤其是胃肠道症状较为常见。3例患者报告有肌肉骨骼症状，但只有1例肌酸激酶升高。
阿托伐他汀是一种治疗晚期和终末期肾衰竭血脂异常患者的有效降脂药物，且耐受性良好。
