Huang Tao-Min, Wu Vin-Cent, Lin Yu-Feng, Wang Jian-Jhong, Shiao Chih-Chung, Chen Likwang, Chueh Shih-Chieh Jeff, Chueh Eric, Yang Shao-Yu, Lai Tai-Shuan, Lin Shuei-Liong, Chu Tzong-Shinn, Wu Kwan-Dun
Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Zhongzheng, Taipei 100, Taiwan.
Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Zhongzheng, Taipei 100, Taiwan.
J Clin Med. 2018 Sep 17;7(9):285. doi: 10.3390/jcm7090285.
Although statin treatment is recommended for patients with chronic kidney disease (CKD) stages I⁻IV, its potential benefits have not been reported in advanced CKD patients. Non-diabetic patients with advanced CKD (pre-dialysis patients, estimated glomerular filtration rate <15 mL/min/1.73 m²) were enrolled from a National Health Insurance Research Database with a population of 23 million. Statin users and non-users were matched using propensity scoring and analyzed using Cox proportional hazards models, taking mortality as a competing risk with subsequent end-stage renal disease (ESRD) and statin doses as time-dependent variables. A total of 2551 statin users and 7653 matched statin non-users were identified from a total 14,452 patients with advanced CKD. Taking mortality as a competing risk, statin use did not increase the risk of new-onset diabetes mellitus (NODM) or decrease the risk of de novo major adverse cardiovascular events (MACE), but reduced all-cause mortality (hazard ratio (HR) = 0.59 [95% CI 0.42⁻0.84], = 0.004) and sepsis-related mortality (HR = 0.53 [95% CI 0.32⁻0.87], = 0.012). For advanced CKD patients, statin was neither associated with increased risks of developing NODM, nor with decreased risk of de novo MACE occurrence, but with a reduced risk of all-cause mortality, mainly septic deaths.
尽管他汀类药物治疗被推荐用于慢性肾脏病（CKD）I⁻IV期患者，但在晚期CKD患者中其潜在益处尚未见报道。我们从一个拥有2300万人口的国民健康保险研究数据库中纳入了晚期CKD的非糖尿病患者（透析前患者，估计肾小球滤过率<15 mL/min/1.73 m²）。使用倾向评分匹配他汀类药物使用者和非使用者，并采用Cox比例风险模型进行分析，将死亡率作为竞争风险，后续终末期肾病（ESRD）和他汀类药物剂量作为时间依赖性变量。在总共14452例晚期CKD患者中，共识别出2551例他汀类药物使用者和7653例匹配的非使用者。将死亡率作为竞争风险，使用他汀类药物并未增加新发糖尿病（NODM）风险或降低新发主要不良心血管事件（MACE）风险，但降低了全因死亡率（风险比（HR）=0.59 [95%CI 0.42⁻0.84]，P = 0.004）和脓毒症相关死亡率（HR = 0.53 [95%CI 0.32⁻0.87]，P = 0.012）。对于晚期CKD患者，他汀类药物既不增加发生NODM的风险，也不降低新发MACE的风险，但可降低全因死亡率，主要是脓毒症死亡风险。
