The use of statins in patients with chronic kidney disease not in dialysis: A scientific review

• Autor(a) principal: Carneiro,António Vaz
• Data de Publicação: 2012
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692012000100004
• topic: Cardiac prognosis; chronic kidney disease; chronic renal disease; coronary artery disease; statins

Chronic kidney disease is a major risk factor for the incidence and severity of coronary artery disease. Patients with CKD present accelerated atherosclerosis and are prone to serious heart disease, including heart failure, before they ever reach dialysis. They have a worse cardiovascular (CV) prognosis then other patients after acute myocardial infarction (AMI), and after revascularisation. The main aim of this review article is the presentation and discussion of the best available evidence on the use of statins in patients with hyperlipidaemia and CKD not on dialysis. This paper is not based on a systematic review of the best clinical evidence on the subject of statins and CKD. It is a scientific review based on recent studies (randomised controlled trials, systematic reviews and observational studies) on risk modulation with lipid-lowering drugs in CKD. The evidence on which this paper is based was identified by searching the best available secondary sources as well as primary databases if needed. There are a series of statements that can be made on the effects of statins in patients with CKD not on dialysis. Firstly, the combination ezetimibe/simvastatin reduces AMI, non-haemorrhagic stroke and revascularisation in these patients, and a physician needs to treat less than 50 patients over four years to avoid a CV event. Secondly, the combination ezetimibe/simvastatin reduces LDL levels more than simvastatin alone. Thirdly, treatment with atorvastatin plus ACE inhibitors or ARBs may reduce proteinuria and the rate of progression of kidney disease, proteinuria and hypercholesterolaemia. Fourthly, pravastatin was associated with slower renal function decline than placebo in patients with moderate reduced GFR and proteinuria. Fifthly, simvastatin has similar effects on total cholesterol, LDL and triglyceride in CKD patients as it has in patients with normal kidney function. Sixthly, statin use is associated with reduction in albuminuria or proteinuria. Seventhly, statin therapy with rosuvastatin reduced first cardiovascular events and all-cause mortality among men and women with low LDL, elevated CRP and moderate CKD. Finally, pravastatin may not be superior to usual care in preventing end-stage renal disease and addition of atorvastatin to angiotensin-converting enzyme inhibitor or angiotensin receptor blocker may slow progression of renal disease.