Major Rupert W, Cheung Chee Kay, Gray Laura J, Brunskill Nigel J
The John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom; and Departments of Health Sciences, and
Infection, Immunity, and Inflammation, University of Leicester, Leicester, United Kingdom The John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom; and.
Clin J Am Soc Nephrol. 2015 May 7;10(5):732-9. doi: 10.2215/CJN.07460714. Epub 2015 Apr 1.
Multiple meta-analyses of lipid-lowering therapies for cardiovascular primary prevention in the general population have been performed. Other meta-analyses of lipid-lowering therapies in CKD have also been performed, but not for primary prevention. This meta-analysis assesses lipid-lowering therapies for cardiovascular primary prevention in CKD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A systematic review and meta-analysis using a random-effects model was performed. MEDLINE was searched between January 2012 and September 2013 for new studies using predefined search criteria without language restrictions. A number of other sources including previously published meta-analyses were also reviewed. Inclusion criteria were randomized control trials of primary prevention with lipid-lowering therapy in non-end stage CKD.
Six trials were identified, five including patients with stage 3 CKD only. These studies included 8834 participants and 32,846 person-years of follow-up. All trials were post hoc subgroup analyses of statins in the general population. Statins reduced the risk of cardiovascular disease (the prespecified primary outcome) by 41% in stages 1-3 CKD compared with placebo (pooled risk ratio, 0.59; 95% confidence interval [95% CI], 0.48 to 0.72). For the secondary outcomes, the risk ratios were 0.66 (95% CI, 0.49 to 0.88) for total mortality, 0.55 (95% CI, 0.42 to 0.72) for coronary heart disease events, and 0.56 (95% CI, 0.28 to 1.13) for stroke. In study participants with stage 3 CKD specifically, the results were similar.
This meta-analysis suggests that the use of statins in CKD for primary prevention of cardiovascular disease is effective. These findings are consistent with recent guidance for the use of statins in all patients with CKD.
已针对普通人群心血管疾病一级预防的降脂疗法开展了多项荟萃分析。也有针对慢性肾脏病（CKD）患者降脂疗法的其他荟萃分析，但并非针对一级预防。本荟萃分析评估了CKD患者心血管疾病一级预防的降脂疗法。
设计、研究地点、参与者及测量指标：采用随机效应模型进行系统评价和荟萃分析。于2012年1月至2013年9月检索MEDLINE，以查找使用预定义检索标准且无语言限制的新研究。还查阅了包括先前发表的荟萃分析在内的许多其他来源。纳入标准为非终末期CKD患者降脂疗法一级预防的随机对照试验。
共识别出6项试验，其中5项仅纳入3期CKD患者。这些研究纳入了8834名参与者，随访时间共计32846人年。所有试验均为他汀类药物在普通人群中的事后亚组分析。与安慰剂相比，他汀类药物使1 - 3期CKD患者心血管疾病风险（预先设定的主要结局）降低了41%（合并风险比，0.59；95%置信区间[95%CI]，0.48至0.72）。对于次要结局，全因死亡率的风险比为0.66（95%CI，0.49至0.88），冠心病事件的风险比为0.55（95%CI，0.42至0.72），中风的风险比为0.56（95%CI，0.28至1.13）。具体而言，在3期CKD研究参与者中，结果相似。
本荟萃分析表明，在CKD患者中使用他汀类药物进行心血管疾病一级预防是有效的。这些发现与近期关于所有CKD患者使用他汀类药物的指南一致。
