Division of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.
Department of Health Services Administration, China Medical University, Taichung, Taiwan.
Ren Fail. 2024 Dec;46(2):2402508. doi: 10.1080/0886022X.2024.2402508. Epub 2024 Sep 20.
The upper tract urothelial carcinoma (UTUC) risk associated with statin therapy in hyperlipidemic patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) remains obscure.
This retrospective cohort study investigated the UTUC risk for hyperlipidemic patients with CKD or ESKD associated with statin therapy.
From the national insurance claims data of Taiwan, we identified hyperlipidemic patients and established three pairs of statin users and non-users sub-cohorts matched by propensity scores: 401,490 pairs with normal kidney function, 37,734 pairs with CKD, and 6271 pairs with ESKD. Incidence rates and hazard ratio (HR) of UTUC were estimated, by the end of 2016, between statin and non-statin cohorts, and between hydrophilic statins users and lipophilic statins users. Time-dependent model estimated adjusted HR, and sub-distribution HR (sHR) accounting for the competing risk of deaths.
The statin-users with ESKD were at increased UTUC risk (sHR 1.98; 95% confidence interval (CI), 1.28-3.06), significant for younger patients (40-64 years). The incidence was twofold greater in women than in men (31.8 versus 15.9 per 10,000 person-years). Receiving lipophilic statins was associated with increased UTUC risk in CKD and ESKD patients, while receiving hydrophilic statins was associated with increased UTUC risk in ESKD patients.
Patients with ESKD receiving statin were at an increased UTUC risk, significant for younger group (<65 y/o). The positive associations between UTUC and statin persisted in both genders with ESKD, and in therapy with either lipophilic statins or hydrophilic statins. Statin users with ESKD deserve attention for UTUC prevention.
高脂血症合并慢性肾脏病（CKD）和终末期肾病（ESKD）患者使用他汀类药物与上尿路尿路上皮癌（UTUC）风险之间的关系尚不清楚。
本回顾性队列研究旨在探讨他汀类药物治疗与高脂血症合并 CKD 或 ESKD 患者 UTUC 的风险。
我们从台湾全民健康保险理赔数据库中确定了高脂血症患者，并根据倾向评分匹配建立了三组他汀类药物使用者和非使用者亚队列：401490 对肾功能正常者、37734 对 CKD 患者和 6271 对 ESKD 患者。至 2016 年底，我们估计了 UTUC 在他汀类药物组和非他汀类药物组、亲水性他汀类药物使用者和疏水性他汀类药物使用者之间的发生率和风险比（HR）。时间依赖性模型估计了调整后的 HR，以及考虑到死亡竞争风险的亚分布 HR（sHR）。
ESKD 患者使用他汀类药物治疗的 UTUC 风险增加（sHR 1.98；95%置信区间[CI]，1.28-3.06），这在 40-64 岁的患者中更为显著。女性的发病率是男性的两倍（每 10000 人年 31.8 比 15.9）。在 CKD 和 ESKD 患者中，使用疏水性他汀类药物与 UTUC 风险增加相关，而在 ESKD 患者中，使用亲水性他汀类药物与 UTUC 风险增加相关。
接受他汀类药物治疗的 ESKD 患者 UTUC 风险增加，<65 岁的年轻患者更为显著。ESKD 患者中，UTUC 与他汀类药物之间的正相关关系在男女两性以及使用疏水性或亲水性他汀类药物的患者中均存在。ESKD 患者使用他汀类药物应注意预防 UTUC。
