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Statins may delay proteinuria progression in patients with CKD
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Statin use may attenuate reductions in estimated glomerular filtration rate, leading to a modest delay in the progression of pathologic proteinuria among patients with chronic kidney disease, researchers reported in a recent meta-analysis.
Researchers queried PubMed, the Cochrane Central Register of Controlled Trials, Web of Knowledge and ClinicalTrials.gov for randomized controlled trials published between 1987 and 2013. They identified 41 studies with the following characteristics: studies comparing statins vs. control, studies of patients aged >18 years, and studies that reported on kidney function at baseline and trial conclusion, including damage or change in function. The researchers also evaluated the impact of statin duration, and compared the effects of less than 1 year, 1 to 3 years and more than 3 years of therapy. The analysis included data from a total of 88,523 patients.
Statin vs. placebo was assessed across 24 studies of 75,723 patients with estimated glomerular filtration rate (eGFR) >60 mL/min and nine studies of 2,222 patients with eGFR <60mL/min. Patients who received placebo had significantly reduced eGFR compared with patients who received statins. Among patients with eGFR >60 mL/min, the standardized mean difference (SMD) of eGFR from baseline was 0.15 (P=.0004); in patients with eGFR of 30-60 mL/min, the SMD from baseline was 0.09 (P=.02).
Across 21 studies of 3,933 participants that evaluated urinary protein excretion, researchers observed a significantly greater decrease in proteinuria among statin users vs. placebo recipients. In patients with urinary protein excretion of 30 to 300 mg/day, the SMD of proteinuria from baseline was –1.12 (P=.008); in patients with excretion >300 mg/day, the SMD was –0.77 (P=.001).
Researchers observed significantly greater eGFR among patients using high-intensity statins vs. moderate-intensity statins (SMD=.012; P<.00001). Compared with placebo users, eGFR was significantly increased among recipients of both high-intensity (SMD=0.1; P=.03) and moderate-intensity statins (SMD=.15; P=.004).
In addition, eGFR was significantly reduced among placebo recipients compared with those who received less than 1 year (SMD=0.14; P=.04), 1 to 3 years (SMD=.05; P=.003) and more than 3 years of statin therapy (SMD=0.14; P=.007).
The researchers cited the small size of several studies, differing designs and methods across incorporated trials and insufficient data to assess the impact of statins on eGFR and protein excretion among patients with CKD stage 4 or 5 as limitations of the study. However, they noted that their results, similar to prior findings, indicate the potential for statin use to benefit patients with CKD stage 1 to 3.
“Statins appear to decrease the rate of reduction of eGFR and slow the progression of pathologic proteinuria moderately,” the researchers wrote. “… Hopefully, this meta-analysis will provide evidence that treatment with statins may have beneficial effects on the kidney.”
Disclosure: The researchers report no relevant financial disclosures.
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