Medical University of Lodz, Department of Nephrology, Hypertension and Family Medicine, Poland.
Expert Opin Pharmacother. 2010 Nov;11(16):2665-74. doi: 10.1517/14656566.2010.512419.
Patients with end-stage renal disease are at high risk of developing cardiovascular disease, which is characterized by early onset and rapid progression of atherosclerosis. Some analyses of large clinical trials have revealed that statins might reduce all-cause mortality and cardiovascular (CV) events in patients with chronic kidney disease (CKD). Preliminary studies have also suggested that they can reduce contrast-induced nephropathy (CIN) and the rate of loss of kidney function. However, the results concerning the efficacy and safety of statin therapy in patients with CKD, especially in those on renal replacement therapy, are still controversial.
This review contains data on the atherosclerotic risk in patients with CKD; the role of statins in the reduction of CV risk in patients with CKD; the role of CIN; the effects of statins on retarding the progression of CKD; and the efficacy of statin therapy in CKD, dialysis and renal-transplant patients. We searched using the electronic databases [MEDLINE (1966 - June 2010), EMBASE and SCOPUS (1965 - June 2010), DARE (1966 - June 2010)]. Additionally, abstracts from national and international cardiovascular meetings were studied. Where necessary, the relevant authors of these studies were contacted to obtain further data. The main data search terms were: 'statin/statins', 'dialysis', 'dyslipidemia', 'hemodialysis', 'kidney disease', 'microalbuminuria', 'clinical trials', and 'renal impairment'.
Readers will be acquainted with results of clinical trials, including the most recent ones (e.g., PLANETE I and II), and will be able to draw their own conclusions concerning the use of statins in CKD patients on the basis of the results of the studies presented and to compare them with the authors' suggestions presented in this review.
Although the results of trials are conflicting, it is suggested that the benefits of statin use outweigh the drawbacks in patients with early-stage CKD, when the benefits can be effectively predicted. However, available large randomized clinical trials suggest a lack of efficacy in patients on renal replacement therapy.
患有终末期肾病的患者发生心血管疾病的风险很高，其特征为动脉粥样硬化的早期发生和快速进展。一些大型临床试验的分析显示他汀类药物可能降低慢性肾脏病（CKD）患者的全因死亡率和心血管（CV）事件发生率。初步研究还表明，它们可以降低造影剂肾病（CIN）和肾功能丧失的速度。然而，关于 CKD 患者他汀类药物治疗的疗效和安全性的结果，尤其是在接受肾脏替代治疗的患者中，仍然存在争议。
这篇综述包含 CKD 患者的动脉粥样硬化风险的数据；他汀类药物在降低 CKD 患者 CV 风险中的作用；CIN 的作用；他汀类药物对延缓 CKD 进展的影响；以及 CKD、透析和肾移植患者中他汀类药物治疗的疗效。我们使用电子数据库（MEDLINE[1966 年-2010 年 6 月]、EMBASE 和 SCOPUS[1965 年-2010 年 6 月]、DARE[1966 年-2010 年 6 月]）进行了搜索。此外，还研究了来自全国和国际心血管会议的摘要。在必要时，联系了这些研究的相关作者以获取更多数据。主要的数据搜索词是：“他汀类药物/他汀”、“透析”、“血脂异常”、“血液透析”、“肾脏疾病”、“微量白蛋白尿”、“临床试验”和“肾功能不全”。
读者将熟悉临床试验的结果，包括最新的研究（例如 PLANETE I 和 II），并能够根据提出的研究结果得出自己关于 CKD 患者使用他汀类药物的结论，并将其与本文提出的作者建议进行比较。
尽管试验结果存在冲突，但建议在早期 CKD 患者中，当获益能够有效预测时，使用他汀类药物的益处超过了缺点。然而，现有的大型随机临床试验表明，在接受肾脏替代治疗的患者中，疗效缺乏。
