Robertson Centre for Biostatistics, University of Glasgow, Glasgow G12 8QQ, UK.
Medical Unit, Dumfries and Galloway Royal Infirmary, Dumfries DG1 4AP, UK.
QJM. 2017 Aug 1;110(8):493-500. doi: 10.1093/qjmed/hcx040.
Attempts to reduce the burden of vascular disease in advanced chronic kidney disease (CKD) by control of lipids have not been as successful as predicted.
To determine the extent to which the effectiveness of statins varies by kidney class.
Meta-analysis.
We selected randomized trials of statin vs. placebo that gave outcomes for CKD3 (eGFR 30-59 ml/min), CKD4 (eGFR 15-29 ml/min), CKD5 (eGFR < 15 ml/min)/5D(dialysis) and transplant patients separately. Data sources were the Cholesterol Triallists' Treatment Collaboration and previously published meta-analyses. Main outcome measures were major cardiovascular events (MACE), cardiovascular death and all-cause mortality (ACM).
A total of 13 studies provided 19 386 participants with CKD3, 2565 with CKD4, 7051 with CKD5/5D and 2102 with a functioning renal transplant. Statins reduced MACE (pooled HR 0.72, 95% CI 0.67-0.78) and ACM (0.82, 0.73-0.91) in CKD3; probably reduced MACE (0.78, 0.62-0.99) in CKD4; and probably reduced cardiovascular death (0.62, 0.40-0.96) in renal transplants. There were no cardiovascular or ACM data in CKD4; there was no convincing evidence of benefit for any outcome in CKD5/5D; and no significant reduction in MACE or ACM in patients with a functioning transplant.
Statins are indicated in CKD3, probably indicated in CKD4, not indicated in CKD5/5D and probably indicated in patients with a functioning transplant. Too few patients with CKD4 and renal transplants have been included in lipid lowering trials for confident conclusions to be drawn.
通过控制血脂来降低晚期慢性肾脏病（CKD）血管疾病负担的尝试并未取得预期效果。
确定他汀类药物的疗效在多大程度上因肾脏类别而异。
荟萃分析。
我们选择了他汀类药物与安慰剂对照的随机试验，分别为 CKD3（eGFR 30-59ml/min）、CKD4（eGFR 15-29ml/min）、CKD5（eGFR <15ml/min）/5D（透析）和移植患者提供结局数据。数据来源为胆固醇三联治疗协作组和以前发表的荟萃分析。主要观察指标为主要心血管事件（MACE）、心血管死亡和全因死亡率（ACM）。
共有 13 项研究提供了 19386 例 CKD3 患者、2565 例 CKD4 患者、7051 例 CKD5/5D 患者和 2102 例功能肾移植患者的数据。他汀类药物降低了 CKD3 患者的 MACE（汇总 HR 0.72，95%CI 0.67-0.78）和 ACM（0.82，0.73-0.91）；可能降低了 CKD4 患者的 MACE（0.78，0.62-0.99）；并可能降低了肾移植患者的心血管死亡（0.62，0.40-0.96）。CKD4 中没有心血管或 ACM 数据；CKD5/5D 中没有任何结果获益的令人信服证据；功能肾移植患者中 MACE 或 ACM 无明显降低。
他汀类药物适用于 CKD3，可能适用于 CKD4，不适用于 CKD5/5D，可能适用于功能肾移植患者。由于纳入降脂试验的 CKD4 和肾移植患者太少，无法得出有信心的结论。
