META-ANALYSIS OF IMPACT OF STATINS ON RENAL FUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 3 AND 4

Abstract

Therapeutic Area

Kidney Disease

Background

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death in CKD patients. CKD patients have highly atherogenic dyslipidemia characterized by small, dense LDL particles. Statins remain the foundation of therapy for reducing the enhanced ASCVD risk. Due to concerns regarding futility, competing risks, and polypharmacy in very advanced CKD patients, lipid-lowering therapy is often underutilized in this high-risk population. We performed a systematic review to study the impact of statins on the estimated glomerular filtration rate (eGFR) in patients with CKD stages 3 to 4 at baseline.

Methods

We screened articles in PubMed and Cochrane Library, published in the English language between 01/01/1990 and 01/01/2024. We included randomized clinical trials enrolling patients with moderate to severe CKD, who were treated with a statin medication as the main intervention, had a follow-up duration of at least 12 months, and reported an eGFR at the beginning and the conclusion of the study. The mean annual change in eGFR was the primary outcome of interest. A random-effects model was used to assess the impact of statin treatment compared to the control on the annual change in eGFR.

Results

1941 studies were initially identified. 13 RCTs, comprising 14,393 individuals on statin therapy, were finally included. 6 studies were evaluated statins in primary ASCVD prevention, 6 evaluated statins in secondary ASCVD prevention. In many included studies, the risk of bias was deemed to be low. The average follow-up ranged from 12 months to 6 years. The pairwise meta-analysis revealed that statin use slowed the rate of eGFR decline by 0.24 mL/min/1.73 m2 per year (p = 0.0003) more compared to controls. Eggerʼs test showed no evidence of publication bias (p = 0.13).

Conclusion

Statin therapy in patients with CKD stages 3 & 4 had a beneficial, albeit small, effect on renal function by reducing the rate of decline in eGFR over time. Thus, statins can be safely used in this high-risk population. Future, larger studies should evaluate the potential benefit of apoB lowering drugs on renal function in moderate to advanced CKD and the potential interaction of other renoprotective drugs in this population.