Chung Chang-Min, Lin Ming-Shyan, Hsu Jen-Te, Hsiao Ju-Feng, Chang Shih-Tai, Pan Kuo-Li, Lin Chun-Liang, Lin Yu-Sheng
School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Division of Cardiology, Chang Gung Memorial Hospital, Yunlin, Taiwan.
J Clin Lipidol. 2017 Mar-Apr;11(2):422-431.e2. doi: 10.1016/j.jacl.2017.01.001. Epub 2017 Jan 21.
Treatment with statin may be beneficial for patients with chronic kidney disease (CKD). However, the debate over the clinical importance of statin in patients with predialysis advanced CKD remains unresolved.
The objective of the article was to evaluate the effect of statin on mortality, cerebrovascular, and renal outcomes in patients with predialysis advanced CKD and dyslipidemia.
Data on predialysis advanced CKD patients were retrieved from the National Health Insurance Research Database based on the guidelines for prescribing regular erythropoietin-stimulating agent in CKD patients. Patients with dyslipidemia were further selected and divided into 2 groups by their statin use after the prescribed erythropoietin-stimulating agent. All-cause mortality and cerebrovascular and renal outcomes were analyzed after propensity score matching.
There were 2016 and 14,412 patients in the statin and nonstatin groups. Their average follow-up periods were 3.7 and 3.0 years, respectively. After 1:2 propensity score matching, the annual all-cause mortality rate was higher in the nonstatin than in the statin group (143.99 vs 109.50 per 1000 person-years; P < .001; hazard ratio: 0.73; 95% confidence interval: 0.68-080). The annual risk of ischemic stroke (P = .186) and intracranial hemorrhage (P = .322) were not significantly different between the 2 groups. The nonstatin group had a higher risk of dialysis than the statin group (1269.45 vs 1095.00 per 1000 person-years; P = .002). Adverse events were not significant between the 2 groups.
Statins may reduce the all-cause mortality and reduced the risk of dialysis in patients with predialysis advanced CKD and dyslipidemia. However, statins have no impact on ischemic-hemorrhage stroke.
他汀类药物治疗可能对慢性肾脏病（CKD）患者有益。然而，关于他汀类药物在透析前晚期CKD患者中的临床重要性的争论仍未解决。
本文的目的是评估他汀类药物对透析前晚期CKD和血脂异常患者的死亡率、脑血管和肾脏结局的影响。
根据CKD患者常规促红细胞生成素刺激剂的处方指南，从国家健康保险研究数据库中检索透析前晚期CKD患者的数据。进一步选择血脂异常患者，并在开具促红细胞生成素刺激剂后根据他汀类药物的使用情况将其分为两组。在倾向得分匹配后分析全因死亡率、脑血管和肾脏结局。
他汀类药物组和非他汀类药物组分别有2016例和14412例患者。他们的平均随访期分别为3.7年和3.0年。在1:2倾向得分匹配后，非他汀类药物组的年度全因死亡率高于他汀类药物组（每1000人年143.99例对109.50例；P <.001；风险比：0.73；95%置信区间：0.68 - 0.80）。两组之间缺血性中风（P =.186）和颅内出血（P =.322）的年度风险无显著差异。非他汀类药物组的透析风险高于他汀类药物组（每1000人年1269.45例对1095.00例；P =.002）。两组之间不良事件不显著。
他汀类药物可能降低透析前晚期CKD和血脂异常患者的全因死亡率并降低透析风险。然而，他汀类药物对缺血性出血性中风没有影响。
