Impact of statin therapy on mortality in chronic kidney disease patients without atherosclerotic cardiovascular disease: insights from american and chinese cohorts (MIMIC-IV and CIN-II Databases)

Background & Objective Patients with chronic kidney disease (CKD) without atherosclerotic cardiovascular disease (ASCVD) have high mortality rates. The KDIGO guidelines indicate that statin therapy can reduce mortality in CKD patients with ASCVD; however, its benefits in CKD patients without ASCVD remain unclear. This study examines the survival benefit of statin in patients with CKD patients without ASCVD in American and Chinese real world Cohorts. Methodologies This study included 4,369 patients diagnosed with CKD without concurrent ASCVD,The cohorts were drawn from two distinct sources: 1,786 patients were identified from the American Medical Information Mart for Intensive Care (MIMIC)-IV database, and 2,583 patients were sourced from the Chinese Multicenter Registry Cohort Cardiorenal Improvement II (CIN-II). Participants were stratified into two groups based on their use of statin therapy: those receiving statin treatment and those not. The primary outcome measure was all-cause mortality. Cox proportional hazards regression models were employed to evaluate the relationship between statin therapy and mortality outcomes, adjusting for potential confounders such as age, sex, hypertension, diabetes, and other relevant clinical variables. Results In the MIMIC-IV cohort, 37.6% of CKD patients were on statin therapy, and the 4-year all-cause mortality rate was 36.3%. Statin use in this cohort was associated with a significant reduction (may reduce) in all-cause mortality (HR = 0.61, 95% CI: 0.51-0.72, P < 0.001). In the CIN-II cohort, 33.9% of CKD patients were on statin therapy, the 4-year all-cause and cardiovascular mortality rates were 10.5% and 5.3%, respectively. Statin therapy significantly reduced both all-cause mortality (HR = 0.74, 95% CI: 0.56-0.99, P = 0.037) and cardiovascular mortality (HR = 0.64, 95% CI: 0.42-0.97, P = 0.031). Conclusion Approximately two-thirds of CKD patients without ASCVD in both the American (MIMIC-IV) and Chinese (CIN-II) cohorts were not receiving statin therapy. Statins therapy may reduce the 4-year all-cause mortality by 26% and 39% in the American and Chinese cohort separately. These findings highlight a survival benefit of statins, which requires future randomized controlled trials.