Opinions of nephrologists on the efficacy and tolerance of statins in hemodialysis patients

Abstract

Large randomized controlled trials have not confirmed the effects of statin therapy on reduction of cardiovascular morbidity and mortality in end-stage kidney disease, despite that statins are still widely prescribed by nephrologists to chronic dialysis patients. The aim of the study was to analyze the attitudes of nephrologists towards statin use in hemodialysis patients. Self-designed questionnaire, containing 18 questions, was distributed among 115 nephrologists. The survey contained description of the results of 3 largest statin trials in nephrology. The questions referred to the interpretation of trial results and the safety and efficacy of statin therapy and dose adjustments required in dialysis patients. 83% among 72 nephrologists who returned the questionnaire prescribed statins to their dialysis patients for secondary prevention of cardiovascular events. 90% prescribed atorvastatin. 64% nephrologists did not modify statin dose at the start of hemodialysis treatment and 47% before elective surgery. Liver disease was indicated as a main reason for dose modification in hemodialysis patients. Statin-induced myopathy was observed by 65% nephrologists and 61% reported a case of increased liver enzymes. 51% of nephrologists did not routinely discuss the possible benefits and risks of statin therapy with their patients. Statins are still widely prescribed and considered safe and effective lipid-lowering therapy in dialysis patients by most nephrologists.

Keywords: Hemodialysis therapy; drug safety; expert opinion; statins; survey.

Figure 1.

Adverse effects of statins reported by the nephrologists in their chronic dialysis patients.