Low-dose atorvastatin in severe chronic kidney disease patients: A randomized, controlled endpoint study

Stegmayr, Bernd; Brännström, Mats; Bucht, S; Crougneau,; Dimény, Emöke; Ekspong, A; Eriksson, Marie; Granroth, B; Gröntoft, KC; Hadimeri, Henrik; Holmberg, Benny; Ingman, B; Isaksson, B; Johansson, Gerd; Lindberger, Kerstin; Lundberg, Lennart; Mikaelsson, L; Olausson, Eric; Persson, Bengt; Stenlund, Hans; Wikdahl, Ann Marie

doi:10.1080/00365590500329304

Cited by 42 publications

(40 citation statements)

References 32 publications

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“…The included studies also showed low heterogeneity (I 2 =18.8%). In sensitivity analysis the exclusion of data from the trial lacking double blinding 17 did not significantly alter the results for infection related mortality (0.98, 0.84 to 1.14).…”

Section: Statin Treatment and Outcome Eventsmentioning

confidence: 93%

“…Three of the trials stated they were randomised but did not give the specific method of sequence generation, although they did state that investigators and participants were blinded to the process of randomisation. Except for one trial, 17 study quality was satisfactory overall and the trials were judged to be at low risk of bias (adequate sequence generation or allocation concealment, double blinding, and clear reporting of withdrawal rates and loss to follow-up). All trials were based on intention to treat analysis of long term treatments.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

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Statins and prevention of infections: systematic review and meta-analysis of data from large randomised placebo controlled trials

Hoek

Bos

Boer

et al. 2011

BMJ

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Objective To evaluate whether the potential of statins to lower the risk of infections as published in observational studies is causal.Design Systematic review and meta-analysis of randomised placebo controlled trials.Data sources Medline, Embase, and the Cochrane Library.Study selection Randomised placebo controlled trials of statins (up to 10 March 2011) enrolling a minimum of 100 participants, with follow-up for at least one year. Data extraction Infection or infection related death.Results The first study selection yielded 632 trials. After screening of the corresponding abstracts and full text papers, 11 trials totalling 30 947 participants were included. 4655 of the participants (2368 assigned to statins and 2287 assigned to placebo) reported an infection during treatment. Meta-analysis showed no effect of statins on the risk of infections (relative risk 1.00, 95% confidence interval 0.96 to 1.05) or on infection related deaths (0.97, 0.83 to 1.13). ConclusionThese findings do not support the hypothesis that statins reduce the risk of infections. Absence of any evidence for a beneficial effect in large placebo controlled trials reduces the likelihood of a causal effect as reported in observational studies.

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Section: Statin Treatment and Outcome Eventsmentioning

confidence: 93%

Section: Baseline Characteristicsmentioning

confidence: 99%

Statins and prevention of infections: systematic review and meta-analysis of data from large randomised placebo controlled trials

Hoek

Bos

Boer

et al. 2011

BMJ

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“…They received more statins and had higher LDL cholesterol levels than the exposed subjects. The lipid-lowering effect of sevelamer hydrochloride on LDL cholesterol is well established [13,14], though this benefit has not been clearly associated with improved survival in HD patients [15,16]. In the present cross-sectional study, subjects exposed to the drug had significantly lower carotid IMT associated with lower LDL cholesterol, yet were prescribed fewer statins and aspirin.…”

Section: Discussionmentioning

confidence: 51%

Effect of Sevelamer Hydrochloride Exposure on Carotid Intima Media Thickness in Hemodialysis Patients

et al. 2010

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Background: Elevated phosphorus (P) and calcium (Ca)-P product (Ca × P) are associated with vascular calcification and cardiovascular disease (CVD) morbidity and CVD and all-cause mortality. Objectives: This study examined the effect of sevelamer hydrochloride exposure (regardless of calcium carbonate exposure) on carotid and femoral intima media thickness (IMT), reliable surrogate measures of prospective intimal thickening, in end-stage renal disease patients on maintenance hemodialysis. Methods: The present cross-sectional study is nested in the Sevelamer hydrochloride and ultrasound-measured femoral and carotid intima media thickness progression in end-stage renal disease (SUMMER) clinical trial. Carotid and femoral arteries were visualized in B-mode ultrasonography. Log-transformed IMT was compared by sevelamer hydrochloride exposure and modeled using multiple linear regression. Results: Forty-five subjects were exposed to sevelamer hydrochloride and 130 were not. Exposed subjects had significantly lower carotid IMT, an association which persisted in the multiple linear regression model even after controlling for potentially confounding variables including serum Ca, history of CVD and body weight. Exposed subjects had lower low-density lipoprotein cholesterol levels and significantly higher parathyroid hormone, but no differences in P, Ca and Ca × P. Conclusions: Sevelamer hydrochloride was associated with lower carotid IMT. This association may be mediated through reduction in Ca load, low-density lipoprotein cholesterol lowering or some other pleiotropic effect.

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“…No effect was found on all-cause mortality. A very small study (n=143) on adult patients with severe CKD (eGFR<30 ml/min/1.73m 2 ) and did not show statistically significant benefit from treatment with atorvastatin, but this could well be due to lack of power [30].…”

Section: Treatment Studies In Ckd Stages 2-4mentioning

confidence: 99%

Dyslipidemia in children with CKD: should we treat with statins?

Tullus

2011

Pediatr Nephrol

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Dyslipidemia has been shown to be a risk factor for increased cardiovascular morbidity and mortality in adult patients with chronic kidney disease (CKD) stages 2-4. In patients on dialysis, a paradoxical correlation has been found between low cholesterol values and increased mortality rates. No data exist in children. Treatment with statins has been convincingly shown to both reduce blood lipid levels and mortality rates from cardiovascular disease in adult patients in CKD stages 2-4. There is no strong literature support for treating patients on dialysis or after having had a transplant. Data on benefits of statin therapy do not exist in children with CKD. There are many differences between adult and paediatric kidney patients, and I caution on extrapolating the findings in adult patients to children. Studies are thus needed to evaluate the benefits and potential problems of statin treatment in children with CKD.

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Low-dose atorvastatin in severe chronic kidney disease patients: A randomized, controlled endpoint study

Cited by 42 publications

References 32 publications

Statins and prevention of infections: systematic review and meta-analysis of data from large randomised placebo controlled trials

Statins and prevention of infections: systematic review and meta-analysis of data from large randomised placebo controlled trials

Effect of Sevelamer Hydrochloride Exposure on Carotid Intima Media Thickness in Hemodialysis Patients

Dyslipidemia in children with CKD: should we treat with statins?

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