Prescribing Advice for GPs

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Statins safe and effective in CKD

The British Medical Journal has made the results of a meta-analysis into the efficacy of statins in patients with chronic kidney disease (CKD) available early online.

The study examined data from fifty trials including 30,144 patients although not all studies were included for all analyses. Treatment with a statin significantly lowered total cholesterol, low density lipoprotein and levels of proteinuria but had no effect on glomerular filtration rate.

In looking at patient orientated outcomes, fatal and non-fatal cardiovascular events were both statistically reduced. Fatal cardiovascular events were reduced by 19% (95% CI 0.73 to 0.90, p < 0.001) and non-fatal events were reduced by 22% (95% CI 0.73 to 0.84, p < 0.001). Withdrawal rates were not statistically different when comparing statin and placebo arms.

The authors conclude that, "statin treatment is safe and reduces the risk of major cardiovascular events in patients with chronic kidney disease". It is also noted that an effect on all-cause mortality was not detected but that this may be due to inadequate statistical power and populations chronic kidney disease are understudied. Finally, attention is drawn to on-going randomised controlled trials in chronic kidney disease patients that aim to clarify the role of statins in primary prevention.

Action: Clinicians should ensure that patients with CKD and existing cardiovascular disease are offered treatment with a statin. Other patients with CKD should be risk assessed for cardiovascular disease and offered treatment appropriate to their level of risk.

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