Effect of Statins on Kidney Disease Outcomes: A Systematic Review and Meta-analysis

Abstract

Background: The effects of statin administration on kidney disease outcomes remain controversial. We undertook a systematic review and meta-analysis to assess the efficacy of statins on kidney outcomes.

Study design: We conducted a meta-analysis of randomized controlled trials (RCTs) using MEDLINE (1946 to August 31, 2015), EMBASE (1966 to August 31, 2015), and the Cochrane Library database (no date restriction).

Setting & population: Adults who were not receiving dialysis, for whom kidney disease outcomes were reported.

Selection criteria for studies: RCTs in which statins were given for at least 6 months and kidney outcomes were measured.

Intervention: Statins versus control, including placebo, usual care, and different types or doses of statins.

Outcomes: Kidney failure events, rate of change in estimated glomerular filtration rate (eGFR) per year, change in proteinuria or albuminuria, and, in patients with chronic kidney disease, major cardiovascular events.

Results: 57 eligible studies with 143,888 participants were included. Statin treatment did not produce an apparent beneficial effect for kidney failure events (OR, 0.98; 95% CI, 0.87-1.10; P=0.7) or end-stage renal disease events (OR, 0.98; 95% CI, 0.90-1.07; P=0.7). However, mean difference for rate of decline in eGFR (0.41 [95% CI, 0.11-0.70] mL/min/1.73m(2) per year slower in statin recipients) and standardized mean difference for change in proteinuria or albuminuria (-0.65 [95% CI, -0.94 to -0.37] standard deviation units, statin recipients vs controls) were statistically significant. In addition, statin therapy significantly reduced the risk for cardiovascular events (OR, 0.69; 95% CI, 0.61-0.79; P<0.001) in patients with chronic kidney disease.

Limitations: Inclusion of several post hoc analyses from large RCTs and substantial heterogeneity in secondary outcome analyses.

Conclusions: Statin therapy does not reduce the risk for kidney failure events in adults not receiving dialysis for whom kidney disease outcomes were reported, but may modestly reduce proteinuria and rate of eGFR decline.

Keywords: Chronic kidney disease (CKD); albuminuria; atorvastatin; cardiovascular events; dyslipidemia; estimated glomerular filtration rate (eGFR); hydroxymethylglutaryl-CoA reductase inhibitor; kidney disease outcomes; kidney failure; lipid lowering; pravastatin; proteinuria; rosuvastatin; simvastatin; statins; systematic review.