| Objective: Statins are 3-Hydroxy-3-methylglutaryl-coenzyme A(HMG-Co A) reductase inhibitors,which are well known for their good effects on preventing cardiovascular disease and improving lipid profiles. However, the effects of statins on renal outcomes, including decline inestimated glomerular filtration rate(e GFR) and proteinuria in patients with chronic kidney disease(CKD), are controversial. We aimed to systematically review the efficacy and safety of Atorvastatin on renal function. Methods : We searched databases including Pub Med, EMbase, The Cochrane Library,CNKI,Wan Fang Data(as of March 2016). The inclusion criterias were published randomized controlled trials(RCTs) comparing Atorvastatin therapy with placebo or usual care or no statins in adult patients, excluding the clinical studies in dialysis patients and children. Two reviewers independently filtered and reviewed the articles. Data concerning study design, participant characteristics, interventions, outcome measures and adverse events were independently extracted. Statistical analyses were calculated by Review Manager 5.3 software. Heterogeneity of the studies was assessed by the χ2-based Q statistic and I-squared(I2) test, which were the basis that we adopt fixed-effects model or random-effect model. Results: Seventeen randomized controlled trials(RCTs)with 11,841 patients were included,including 8 English papers and 9 Chinese papers. These people were randomized to receive either Atorvastatin therapy(6026) or control group(5815). Comparing with control, Atorvastatin significantly influenced glomerular filtration rate(GFR)in patients without dialysis:SMD=0.32,95%CI(0.14,0.5),P<0.001; In our subgroup analysis by ethnicity group, Atorvastatin had a more significant influence on e GFR in Asians than no-Asians [SMD=0.63,95%CI(0.31,0.49), P<0.001 ] vs.[SMD=0.09,95%CI(0.05,0.13),P<0.001]. What’s more,comparing with control group,Atorvastatin significantly influenced urine protein excretion(UPE) in patients without dialysis :WMD=-0.57g/d,95%CI(-0.70,-0.45), P < 0.001;There were six randomized controlled trials provide full data of urinary albumin excretion rate(UAER),and because of substantial heterogeneity we gave up Meta analysis. Comparing with control group, Atorvastatin could reduce the C-reactive protein(CRP) in population with chronic kidney disease(CKD) not requiring dialysis :WMD=-1.01mg/L, 95%CI(-1.45,-0.57),P<0.001,but there was no difference on interleukins 6(IL-6) and tumor necrosis factor α(TNF-α) between Atorvastatin therapy and control group in our Meta analysis: [WMD=-0.59pg/m L, 95%CI(-2.50,1.31),P=0.54] and [WMD=-0.59pg/m L, 95%CI(-2.00, 0.82), P=0.41]. According to the security, atorvastatin treatment was higher than the control group of transaminases associated probability: RR=2.34,95%CI( 1.08,5.08), P=0.03.But small doses of atorvastatin treatment compared with control group, there was no significant difference on two groups of transaminase lifts :RR=1.43,95%CI(0.86,2.38),P=0.17. As for the difference between, there was no statistically significant difference on the incidence of nausea, abdominal pain and muscle pain in patients without dialysis: RR=4.19,95%CI( 0.72,24.50), P=0.11 、 RR=0.89,95%CI(0.74,1.08),P=0.25.Conclusion: Atorvastatin might delay the lost of glomerular filtration rate and reduce urinary protein in patients without dialysis. The protection effect of the Glomerular rate on Asian people might more remarkable than on the non-Asians. In addition to its lipid-lowering effect, Atorvastatin might decrease in inflammatory parameters in population with CKD not requiring dialysis. Low-intensity Atorvastatin was security, but high-intensity might increase the risk of liver damage. Since the limitation of quantity and quality of included studies, large-scale high-quality RCTs are needed to verify our conclusions. |
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