Impact of Statin Therapy on Mortality and Cardiovascular Outcomes in End-Stage Renal Disease: A Systematic Review and Meta-Analysis

Cardiovascular disease (CVD) is the leading cause of death among patients with end-stage renal disease (ESRD). The majority of the randomized controlled trials (RCTs) evaluating statin therapy in patients with dialysis did not show statistically significant mortality benefit. In contrast, recent observational studies have consistently demonstrated improvement in mortality. Although the benefits of statin in this population remain controversial, there is also ambiguity regarding the benefit of statin therapy in patients with dialysis and established atherosclerotic cardiovascular disease (ASCVD). A systematic review and meta-analysis was conducted to evaluate the effects of statin therapy in patients with ESRD using the PubMed and Google Scholar databases. Our objective was to assess all-cause and cardiovascular mortality in mixed ESRD populations (with and without ASCVD), as well as in patients with ESRD and established ASCVD. A total of 396,163 patients in 28 studies were included. Overall, statin therapy significantly reduced all-cause mortality [hazard ratios (HR) = 0.75; 95% confidence intervals (CI, 0.68-0.83)] and cardiovascular mortality (HR = 0.75; 95% [CI, 0.60-0.94]). The majority of the benefits were associated with observational data whereas RCTs did not show any mortality benefits. Among patients with ESRD and established ASCVD in observational studies, statin therapy was associated with reduced all-cause mortality (HR = 0.84; 95% [CI, 0.74-0.95]), but there were little or no cardiovascular mortality benefits. There was substantial heterogeneity amongst the studies. In conclusion, real-world data demonstrated the beneficial role of statins in the ESRD population. These findings are hypothesis-generating and highlight the need for prospective trials focused on patients with ESRD and established ASCVD.