Hsiao Ching-Chung, Yeh Jih-Kai, Li Yan-Rong, Sun Wei-Chiao, Fan Pei-Yi, Yen Chieh-Li, Chen Jung-Sheng, Lin Chihung, Chen Kuan-Hsing
Department of Nephrology, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Front Pharmacol. 2022 Sep 30;13:996237. doi: 10.3389/fphar.2022.996237. eCollection 2022.
Statins are commonly used for cardiovascular disease (CVD) prevention. Observational studies reported the effects on sepsis prevention and mortality improvement. Patients with chronic kidney disease (CKD) are at high risk for CVD and infectious diseases. Limited information is available for statin use in patients with non-dialysis CKD stage V. The retrospective observational study included patients with non-dialysis CKD stage V, with either statin use or none. Patients who were prior statin users and had prior cardiovascular events were excluded. The key outcomes were infection-related hospitalization, major adverse cardiovascular events (MACE) (non-fatal myocardial infarction, hospitalization for heart failure, or non-fatal stroke), and all-cause mortality. The data were retrieved from the Chang Gung Research Database (CGRD) from January 2001 to December 2019. Analyses were conducted with Cox proportional hazard regression models in the propensity score matching (PSM) cohort. A total of 20,352 patients with CKD stage V were included (1,431 patients were defined as statin users). After PSM, 1,318 statin users were compared with 1,318 statin non-users. The infection-related hospitalization (IRH) rate was 79.3 versus 94.3 per 1,000 person-years in statin users and statin non-users, respectively [hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.74-0.93, = 0.002]. The incidence of MACE was 38.9 versus 55.9 per 1,000 person-years in statin users and non-users, respectively (HR, 0.72; 95% CI 0.62-0.83, < 0.001). The all-cause mortality did not differ between statin users and non-users, but statin users had lower infection-related mortality than non-users (HR, 0.59; 95% CI 0.38-0.92, = 0.019). use of statin in patients with non-dialysis CKD stage V reduced the incidence of cardiovascular events, hospitalization, and mortality for infectious disease. The study results reinforced the benefits of statin in a wide range of patients with renal impairment before maintenance dialysis.
他汀类药物常用于预防心血管疾病（CVD）。观察性研究报告了其对预防脓毒症和改善死亡率的作用。慢性肾脏病（CKD）患者发生心血管疾病和感染性疾病的风险很高。关于非透析CKD 5期患者使用他汀类药物的信息有限。这项回顾性观察性研究纳入了非透析CKD 5期患者，分为使用他汀类药物组和未使用组。曾使用他汀类药物且有心血管事件史的患者被排除。主要结局包括与感染相关的住院、主要不良心血管事件（MACE）（非致命性心肌梗死、因心力衰竭住院或非致命性中风）以及全因死亡率。数据取自2001年1月至2019年12月的长庚研究数据库（CGRD）。在倾向评分匹配（PSM）队列中采用Cox比例风险回归模型进行分析。共纳入20352例CKD 5期患者（1431例患者被定义为他汀类药物使用者）。PSM后，将1318例他汀类药物使用者与1318例非使用者进行比较。他汀类药物使用者和非使用者与感染相关的住院（IRH）率分别为每1000人年79.3例和94.3例[风险比（HR）0.83，95%置信区间（CI）0.74 - 0.93，P = 0.002]。他汀类药物使用者和非使用者的MACE发生率分别为每1000人年38.9例和55.9例（HR，0.72；95%CI 0.62 - 0.83，P < 0.001）。他汀类药物使用者和非使用者的全因死亡率无差异，但他汀类药物使用者的感染相关死亡率低于非使用者（HR，0.59；95%CI 0.38 - 0.92，P = 0.019）。非透析CKD 5期患者使用他汀类药物可降低心血管事件、住院率和感染性疾病死亡率。研究结果强化了他汀类药物在维持性透析前广泛的肾功能损害患者中的益处。
