International Medical School, Tianjin Medical University, Tianjin, P.R. China.
School of Public Health, Tianjin Medical University, Tianjin, P.R. China.
Ren Fail. 2021 Dec;43(1):718-728. doi: 10.1080/0886022X.2021.1915799.
Studies have shown that the use of statins could significantly improve lipid profiles; however, it remains controversial whether the use of statins could improve renal function in patients with chronic kidney disease (CKD). Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the effects of statins on renal function in patients with CKD.
We systematically searched PubMed, EMBASE, and the Cochrane Library databases for eligible RCTs from inception to October 2020. Pooled effect estimates were assigned as weighted mean differences (WMDs) with 95% confidence intervals (CIs) using the random-effects model.
We selected 33 RCTs that recruited 37,391 patients with CKD patients. The summary results suggested that statin use significantly reduced urinary albumin (WMD: -2.04; 95%CI: -3.53 to -0.56; = .007) and protein (WMD: -0.58; 95%CI: -0.95 to -0.21; = .002) excretions and increased creatinine clearance (WMD: 0.86; 95%CI: 0.32-1.41; = .002). However, there were no significant differences between statin and control groups in terms of changes in estimated glomerular filtration rate (WMD: 0.38; 95%CI: -0.04 to 0.79; = .075), and serum creatinine levels (WMD: -0.07; 95%CI: -0.25, 0.12; = .475).
We found that statin use in patients with CKD may slow CKD progression by lowering urinary albumin and protein excretions or increasing creatinine clearance. Further large-scale RCTs should be conducted to evaluate the long-term effects of statins on renal outcomes. CKD: chronic kidney disease; RCT: randomized controlled trials; WMD: weighted mean differences; CI: confidence intervals; ACEI: angiotensin-converting enzyme inhibitors; eGFR: estimated glomerular filtration rate.
研究表明，他汀类药物的使用可以显著改善血脂谱；然而，他汀类药物是否可以改善慢性肾脏病（CKD）患者的肾功能仍存在争议。因此，我们进行了一项荟萃分析，以评估他汀类药物对 CKD 患者肾功能的影响。
我们系统地检索了 PubMed、EMBASE 和 Cochrane 图书馆数据库，以获取从成立到 2020 年 10 月的合格随机对照试验（RCT）。使用随机效应模型，将汇总效应估计值指定为加权均数差（WMD）和 95%置信区间（CI）。
我们选择了 33 项 RCT，共纳入 37391 例 CKD 患者。综合结果表明，他汀类药物的使用显著降低了尿白蛋白（WMD：-2.04；95%CI：-3.53 至-0.56； = .007）和蛋白（WMD：-0.58；95%CI：-0.95 至-0.21； = .002）排泄，并增加了肌酐清除率（WMD：0.86；95%CI：0.32-1.41； = .002）。然而，在估计肾小球滤过率的变化方面，他汀类药物组与对照组之间没有显著差异（WMD：0.38；95%CI：-0.04 至 0.79； = .075），以及血清肌酐水平（WMD：-0.07；95%CI：-0.25，0.12； = .475）。
我们发现，在 CKD 患者中使用他汀类药物可能通过降低尿白蛋白和蛋白排泄或增加肌酐清除率来减缓 CKD 进展。应该进行更大规模的 RCT 来评估他汀类药物对肾脏结局的长期影响。CKD：慢性肾脏病；RCT：随机对照试验；WMD：加权均数差；CI：置信区间；ACEI：血管紧张素转换酶抑制剂；eGFR：估计肾小球滤过率。
