What is the issue?
Adults with chronic kidney disease (CKD) have a high risk of cardiovascular events, with elevated serum cholesterol and triglycerides, a factor that contributes to cardiovascular disease. Statin therapy helps to lower the level of bad cholesterol (low-density lipoprotein) and has cardiovascular protective effects beyond cholesterol reduction. For people not needing dialysis, statin therapy has been shown to reduce death and cardiovascular events. Still, studies in this population have shown unclear effects on stroke, kidney failure, and harms such as muscle damage (rhabdomyolysis).
What did we do?
We looked at 62 studies published before 4 October 2023 concerning statins in over 50,000 people with CKD who did not need dialysis treatment. This review is a living systematic review. A search for new evidence will be conducted every three months, and the review will be updated accordingly.
What did we find?
We found that compared to placebo, statin therapy reduced death and major heart-related events, with every 13 people receiving statin therapy avoiding heart-related events and every 26 people avoiding death. Statin therapy probably had little or no effect on stroke and kidney failure (when people would benefit from dialysis or a kidney transplant). The benefits of statin therapy were also evident in patients with CKD but not heart disease. Statins have some potential harms; however, we found there was probably no effect on cancer, liver function or withdrawing from treatment due to adverse events. There was limited reporting of muscle damage in the studies.
Studies did not identify a preferred type or dose of statin in treating people with CKD not requiring dialysis.
Conclusions
Statins decrease death, major cardiovascular events, and myocardial infarction in people with moderate CKD. Limited data related to treatment toxicity resulted in uncertain effects.
Editorial note: Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Authors' conclusions:
Statins reduce death and major cardiovascular events by about 20% and probably make no difference to stroke or kidney failure in people with CKD not requiring dialysis. However, due to limited reporting, the effect of statins on elevated creatinine kinase or rhabdomyolysis is unclear. Statins have an important role in the primary prevention of cardiovascular events and death in people who have CKD and do not require dialysis.
Editorial note: This is a living systematic review. We will search for new evidence every three months and update the review when we identify relevant new evidence. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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