Meta-analysis of the impact of statins on change in renal function in patients with moderate or severe chronic kidney disease

Abstract

Objective: Chronic kidney disease (CKD) patients have an elevated risk of atherosclerotic cardiovascular disease (ASCVD)-statins remain the cornerstone in reducing this increased risk. In prior analyses, statins have been suggested to have a benefit in slowing the decline in renal function over time in mild CKD (ie, stage 1 or 2 CKD, or estimated glomerular filtration rate [eGFR] ≥ 60 mL/min/1.73 m²). Whether these benefits also extend to patients with moderate or severe (ie, stages 3 or 4, or eGFR 15-59 mL/min/1.73 m²) CKD is unknown.

Methods: We performed a meta-analysis to study the effect of statins on the eGFR in patients with stage 3 or 4 CKD. Thirteen randomized controlled trials that included 14,393 patients were included. Six of these studies evaluated statins in primary ASCVD prevention, 6 evaluated statins in secondary prevention, and 1 included both. Follow-up ranged from 12 months to 6 years. The mean eGFR at baseline in the statin and nonstatin groups was 49.03 ± 9.7 and 52.81 ± 9.8 mL/min/1.73 m², respectively.

Results: Compared to controls, the statin group had a slower rate of eGFR decline (difference between the groups = 0.26 mL/min/1.73 m²/y [95% CI: 0.10-0.42; P = .0017]). Meta-regression showed that, except for baseline low-density lipoprotein cholesterol, moderators such as age, diabetes, or hypertension did not explain the residual heterogeneity. Egger's test showed no statistically significant evidence of publication bias (P = .13).

Conclusion: In patients with stage 3 or 4 CKD, compared to placebo, statins slowed the decline in renal function over time, in both primary and secondary prevention patients. Thus, statins can not only reduce adverse cardiovascular outcomes in this patient population but also potentially reduce the loss of renal function.

Keywords: Chronic kidney disease; Estimated glomerular filtration rate; Meta-analysis; Renal function; Statins.