Lipid-lowering therapy in persons with chronic kidney disease: a systematic review and meta-analysis

Abstract

Background: Lipid-lowering therapy is not widely used in persons with chronic kidney disease (CKD) despite a high burden of dyslipidemia and cardiovascular disease in this population.

Purpose: To synthesize evidence examining the effect of lipid-lowering therapy on clinical outcomes in persons with CKD.

Data sources: MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from January 2000 through November 2011.

Study selection: Randomized, controlled trials (RCTs) comparing lipid-lowering therapy with control treatment in persons with CKD, including subgroup analyses of trials in the general population.

Data extraction: Abstracts were screened and data were extracted on study methodology, population, interventions, cardiovascular and kidney outcomes, and adverse events. Data were extracted by one author and confirmed by another. Study quality was determined by consensus. Random-effects model meta-analyses were performed.

Data synthesis: 18 RCTs, all in adults, met the eligibility criteria. Five RCTs involved CKD populations, and 13 were CKD subgroup analyses from trials in the general population. Sixteen RCTs examined statins, and 2 examined statins plus ezetimibe. Lipid-lowering therapy does not improve kidney outcomes but decreases the risk for cardiac mortality (pooled risk ratio [RR] from 6 trials, 0.82 [95% CI, 0.74 to 0.91]; P< 0.001), cardiovascular events (including revascularization) (pooled RR from 9 trials, 0.78 [CI, 0.71 to 0.86]; P< 0.001), and myocardial infarction (pooled RR from 9 trials, 0.74 [CI, 0.67 to 0.81]; P< 0.001). Significant benefit was also seen for all-cause mortality but was limited by a high degree of heterogeneity. No benefit was found for other cardiovascular outcomes. Rates of adverse events were similar between intervention and comparator groups.

Limitations: Lack of data in children, heterogeneity among reviewed studies, and the possibility of selective reporting of outcomes and adverse events.

Conclusion: Lipid-lowering therapy decreases cardiac death and atherosclerosis-mediated cardiovascular events in persons with CKD.