Division of Gastroenterology, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan.
Department of Nephrology, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan.
Sci Rep. 2018 Nov 2;8(1):16276. doi: 10.1038/s41598-018-34632-z.
Dyslipidemia is associated with glomerular injury. However, the effect of statins on chronic kidney disease (CKD) progression remains controversial. We aimed to investigate the efficacy of statins for renal protection in patients with CKD. The retrospective cohort study comprised 3441 patients diagnosed with CKD in multiple medical centers. We divided the patients into two cohorts based on statin prescription, and compared proportions and risks of CKD progression events between the two groups. CKD progression event was defined as an average annual decline of eGFR >5 mL/min/1.73 m or advancement to the dialysis stage. The result revealed that among all incident patients with CKD, 28.7% and 30.3% of the users and nonusers demonstrated CKD progression, respectively. The crude odds ratio (OR) of CKD progression was 0.93 [95% confidence interval (CI) 0.78-1.10]. After adjustment for baseline characteristics, the adjusted OR was 0.80 (95% CI 0.63-1.01). The sensitivity analysis results showed consistent OR for CKD progression, stratification by age, sex, Charlson score, and statins use within 1 year before index date. The effect of statins was significant in patients with CKD stage 3B-5 (OR 0.68, 95% CI 0.48-0.95), but not statistically significant in those with CKD stage 1-3A (OR 0.97, 95% CI 0.68-1.38). The effect of statins was significant in patients with proteinuria ≥1000 mg/day (OR 0.63, 95% CI 0.43-0.92), but not statistically significant in those with proteinuria <1000 mg/day (OR 1.02, 95% CI 0.74-1.41).
血脂异常与肾小球损伤有关。然而,他汀类药物对慢性肾脏病(CKD)进展的影响仍存在争议。我们旨在研究他汀类药物对 CKD 患者的肾脏保护作用。这项回顾性队列研究纳入了多家医疗机构诊断为 CKD 的 3441 例患者。我们根据他汀类药物处方将患者分为两组,并比较了两组患者 CKD 进展事件的比例和风险。CKD 进展事件定义为 eGFR 平均每年下降>5ml/min/1.73m 或进展至透析阶段。结果显示,在所有新发 CKD 患者中,分别有 28.7%和 30.3%的使用者和非使用者发生 CKD 进展。CKD 进展的粗比值比(OR)为 0.93(95%置信区间[CI]0.78-1.10)。调整基线特征后,调整后的 OR 为 0.80(95%CI0.63-1.01)。敏感性分析结果显示,在按年龄、性别、Charlson 评分和索引日期前 1 年内使用他汀类药物分层后,CKD 进展的 OR 一致。他汀类药物对 CKD 3B-5 期患者的作用显著(OR0.68,95%CI0.48-0.95),但对 CKD 1-3A 期患者无统计学意义(OR0.97,95%CI0.68-1.38)。他汀类药物对蛋白尿≥1000mg/天的患者作用显著(OR0.63,95%CI0.43-0.92),但对蛋白尿<1000mg/天的患者无统计学意义(OR1.02,95%CI0.74-1.41)。