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慢性肾脏病中他汀类药物治疗强度与肾脏结局:韩国慢性肾脏病患者结局队列研究结果

Intensity of statin therapy and renal outcome in chronic kidney disease: Results from the Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease.

作者信息

Jhee Jong Hyun, Joo Young Su, Park Jung Tak, Yoo Tae-Hyun, Park Sue Kyung, Jung Ji Yong, Kim Soo Wan, Oh Yun Kyu, Oh Kook-Hwan, Kang Shin-Wook, Choi Kyu Hun, Ahn Curie, Han Seung Hyeok

机构信息

Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

Division of Nephrology, Department of Internal Medicine, Myongji Hospital, Goyang, Republic of Korea.

出版信息

Kidney Res Clin Pract. 2020 Mar 31;39(1):93-102. doi: 10.23876/j.krcp.20.007.

Abstract

BACKGROUND

Higher statin intensity is associated with a lower risk of mortality in patients with cardiovascular disease. However, little is known about the relationship between statin intensity and chronic kidney disease (CKD) progression.

METHODS

We studied whether statin intensity affects kidney function decline in 1,073 patients from the Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease. The participants were classified based on statin intensity as low, moderate, and high. The study endpoint was CKD progression (composite of doubling of serum creatinine, ≥ 50% decrease in estimated glomerular filtration rate [eGFR] from baseline, or end-stage renal disease).

RESULTS

The mean age was 56.0 ± 11.4 years, and 665 (62.0%) participants were male. The mean eGFR was 51.7 ± 26.7 mL/min/1.73 m; there were no differences in baseline eGFR among statin intensity groups. During the median follow-up of 39.9 (25.4-61.6) months, 255 (23.8%) patients reached the study endpoint. In multivariable Cox model after adjustment of confounders, the hazard ratios (95% confidence interval) for adverse kidney outcome were 0.97 (0.72-1.30) and 1.15 (0.60-2.20) in moderate and high statin intensity groups, respectively, compared with the low intensity group. In addition, no significant association was observed in subgroups stratified by age, sex, eGFR, and atherosclerotic cardiovascular disease risk scores.

CONCLUSION

We did not observe any significant association between intensity of statin therapy and progression of CKD. Long-term kidney outcomes may not be affected by statin intensity.

摘要

背景

在心血管疾病患者中,较高的他汀类药物治疗强度与较低的死亡风险相关。然而,关于他汀类药物治疗强度与慢性肾脏病(CKD)进展之间的关系,人们知之甚少。

方法

我们在韩国慢性肾脏病患者队列研究的1073例患者中研究了他汀类药物治疗强度是否会影响肾功能下降。参与者根据他汀类药物治疗强度分为低、中、高组。研究终点为CKD进展(血清肌酐翻倍、估计肾小球滤过率[eGFR]较基线下降≥50%或终末期肾病的复合指标)。

结果

平均年龄为56.0±11.4岁,665例(62.0%)参与者为男性。平均eGFR为51.7±26.7 mL/min/1.73 m²;他汀类药物治疗强度组之间的基线eGFR无差异。在39.9(25.4 - 61.6)个月的中位随访期间,255例(23.8%)患者达到研究终点。在调整混杂因素后的多变量Cox模型中,与低强度组相比,中强度和高强度他汀类药物治疗强度组不良肾脏结局的风险比(95%置信区间)分别为0.97(0.72 - 1.30)和1.15(0.60 - 2.20)。此外,在按年龄、性别、eGFR和动脉粥样硬化性心血管疾病风险评分分层的亚组中未观察到显著关联。

结论

我们未观察到他汀类药物治疗强度与CKD进展之间存在任何显著关联。长期肾脏结局可能不受他汀类药物治疗强度的影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d590/7105621/d9199777b0ce/KRCP-39-093-f1.jpg

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