Meta-analysis Of Prognostic Value Of Statins Therapy For Patients With Chronic Kidney Disease

Objective: To evaluate the effect on all cause mortality, cardiacmortality and cardiovascular events in patients with chronic kidneydisease who were receiving dialysis and not receiving dialysis, and theeffect on change in kidney function.Methods: Randomized controlled trials about statins for chronic kidneydisease in any language were sought using the following sources:Pubmed,Cochrane Library (up to March,2013).16randomized controlledtrials met the inclusion criteria involving32196participants with CKD.Among them22966were not receiving dialysis,7128were receivingdialysis.Two reviewers independently identified the eligible studies,assessed their risk of bias and extracted data. RevMan software5.2wasused for meta-analysis.The end point events were all cause mortality,cardiac mortality, cardiovascular events,endstage renal disease, a25%or more decrease in estimated glomerular filtration rate (eGFR) ordoubling the serum creatinine level.The safety outcomes were the ratesof adverse events and toxicity-related withdrawals.Results: The results of meta-analysis showed: In subjectives notreceiving dialysis，statins therapy significantly reduced all causemortality (RR：0.79,95%CI[0.71,0.87],P<0.00001),cardiac mortality(RR:0.70,95%CI [0.57,0.86],P=0.0006） and cardiovascular events(RR:0.66，95%CI [0.57,0.77],P<0.00001) compared with control group，but in subjectives receiving dialysis, had no significant effect on allcause mortality（RR:0.96，95%CI [0.90,1.02]，P=0.20）,cardiac mortality （RR:0.94,95%CI [0.82,1.07],P=0.33）or cardiovascular events（RR:0.92,95%CI[0.85,1.00]，P=0.05）. Similarly,statins therapy can not slow downthe progression of CKD(a25%or more decrease in estimated glomerularfiltration rate (eGFR) or doubling the serum creatinine level), RR=0.96，95%CI [0.88,1.05]， P=0.36,and prevent endstage renal disease,RR=0.98,95%CI [0.91,1.05],P=0.54。 There were no statisticallydifferences on the rates of adverse events（including rhabdomyolysis,elevated liver enzymes） and toxicity-related withdrawals.Conclusion: These results suggested that statins therapy can improveendpoints of patients with chronic kidney disease, only in patients notreceiving dialysis,but not in pateints receiving dialysis.It had similarefficacy and safety with intervention and comparator groups.