Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy.
Int J Cardiol. 2013 Oct 15;168(6):5437-47. doi: 10.1016/j.ijcard.2013.08.060. Epub 2013 Aug 28.
The efficacy of statin treatment in chronic kidney disease (CKD) patients remains controversial. Therefore, we performed a meta-analysis to investigate whether statins modulate renal function in patients with CKD.
Data from Scopus, PubMed, Web of Science, and the Cochrane Central Register of randomized controlled trials for years 1966-December 2012 were searched for appropriate studies.
Twenty trials with 6452 CKD subjects randomized to receive either statin or placebo were included. Statin therapy significantly influenced high sensitivity C-reactive protein levels in patients on or off dialysis [-0.28 mg/dl, 95%CI: -0.93 to -0.37; p<0.05 and -0.46 mg/dl, 95%CI: -0.87 to -0.05; p=0.03], respectively], urinary protein (-0.77 g/24 h, 95%CI: -1.24 to -0.29, p<0.02; this effect persisted for treatment ≤12 months), and serum creatinine but only for long-term therapy (3 years) (-0.65 mg/dl, 95%CI: -1.00 to -0.30; p=0.0003). The summary for standardized effect size of mean differences of glomerular filtration rate was 0.29 ml/min/1.73 m(2) (95%CI: 0.01 to 0.58; p=0.04), and depended on treatment duration - a significant increase was observed for between 1 and 3 years of statin therapy (0.50 ml/min/1.73 m(2), 95%CI: 0.40 to 0.60; p<0.0001), with no significant increase for both ≤1 and >3 years of the therapy.
Statins might exert significant renoprotective effects in CKD patients; however, benefit may depend on the duration of treatment. This is an issue that warrants more definitive investigation. More studies are necessary in dialysis patients to credibly evaluate the renal effects of statin therapy.
他汀类药物治疗慢性肾脏病（CKD）患者的疗效仍存在争议。因此，我们进行了一项荟萃分析，以研究他汀类药物是否能调节 CKD 患者的肾功能。
检索 1966 年至 2012 年 12 月期间 Scopus、PubMed、Web of Science 和 Cochrane 中心随机对照试验注册库中的相关数据。
纳入了 20 项试验，共纳入 6452 名 CKD 患者，随机接受他汀类药物或安慰剂治疗。他汀类药物治疗可显著影响透析患者和非透析患者的高敏 C 反应蛋白水平[-0.28mg/dl，95%CI：-0.93 至-0.37；p<0.05 和-0.46mg/dl，95%CI：-0.87 至-0.05；p=0.03]、尿蛋白[-0.77g/24h，95%CI：-1.24 至-0.29，p<0.02；这种影响持续了 12 个月]和血清肌酐水平，但仅在长期治疗（3 年）时有效[-0.65mg/dl，95%CI：-1.00 至-0.30；p=0.0003]。肾小球滤过率的标准化均数差值汇总的效应大小为 0.29ml/min/1.73m(2)（95%CI：0.01 至 0.58；p=0.04），且取决于治疗持续时间-他汀类药物治疗 1 至 3 年时观察到显著增加（0.50ml/min/1.73m(2)，95%CI：0.40 至 0.60；p<0.0001），而治疗时间≤1 年和>3 年时则无显著增加。
他汀类药物可能对 CKD 患者有显著的肾脏保护作用，但获益可能取决于治疗持续时间。这是一个需要进一步明确研究的问题。需要更多的研究来评估透析患者他汀类药物治疗的肾脏效应。
