Effects Of Statins On Cardiovascular Outcomes And All-cause Mortality In People With Chronic Kidney Disease:A Meta Analysis

Objective:To evaluate the impact of statin therapy on cardiovascular outcomes and all-cause mortality in patients with CKD via meta-analysis.Methods:We comprehensively searched the databases of Pubmed, Embase, Medline, the China National Knowledge Infrastructure, WanFang database for articles published from January 2000 to September 2015. The inclusion criteria were published RCT studies comparing statin therapy to placebo in patients with CKD (eGFR<90 ml/min/1.73m2) requiring or not requiring dialysis,with statin or placebo therapy lasted at least 6 months, and the follow-up time lasted more than two years. The primary outcome was the differences in the cardiovascular outcomes and all-cause mortality. We used risk ratio (RR) and its 95% confidence interval (95%CI) to evaluate the strength of impact of statin therapy on risk of cardiovascular outcomes and all-cause mortality by STATA12.0.Results; 1. From 112 full-text articles,9 studies were included in the meta-analysis.2 The research shows different effects of statin therapy on the risk of cardiovascular outcomes and all-cause mortality of patients on different stage of chronic kidney disease (CKD). The effect wakens with the decrease of renal function.3. In patients of stage 2-3 chornic kidney disease (30 ml/min/1.73 m2< eGFR< 90 ml/min/1.73 m2), compared with the placebo group, the use of statins can reduce the happening of cardiovascular events (RR=0.868,95%CI[0.823,0.917]), and all-cause mortality (RR=0.805,95%CI[0.735, 0.881]). As for patients of CKD 5 stage, the use of statins has few effects on the happening of cardiovascular events (RR=0.912,95%CI[0.843,0.986], P=0.553), and all-cause mortality (RR =0.956,95%CI [0.860,1.063])4. In patients undergoing dialysis, compared with the placebo group, the use of statins can not significantly reduce the risk of cardiovascular events (RR=0.920,95%CI[0.849,0.997]) and all-cause mortality (RR=0.920,95%CI [0.849,0.997])5. In the subgroup analysis, statin therapy is less effecitive on all-cause mortality in patients with a high risk (>20%) of diabetes (RR=1.067,95%CI [0.945,1.083]) than those who undergoing a low risk (<20%) of diabetes (RR=0.840,95%CI [0.780,0.905])Conclusions:1. There is a difference in cardiovascular outcomes and all-cause mortality in patients with chronic kidney disease (CKD) between the statin therapy and placebo group. The effect wakens with the decrease of renal function.2. In patients with stage 2-3 of chronic disease, the use of statins can reduce the risk of cardiovascular outcomes and all-cause mortality.3. But in patients with stage 5 or undergoing dialysis, this advantage is not significant.4. There is a decrease of the effects of statin therapy on all-cause mortality when patients with chronic kidney disease have a high risk of diabetes. While no sunch fingdings on cardiovascular events.