Key result
De novo statin use in patients with non-dialysis advanced chronic kidney disease was associated with a 17% lower risk of infection-related hospitalization compared to non-users (HR 0.83).
Why the study?
Patients with CKD are at high risk for CVD and infectious diseases, but limited information is available regarding statin use in patients with non-dialysis CKD stage V.
Does de novo statin use reduce infection-related hospitalization, major adverse cardiovascular events, and mortality in adults with non-dialysis advanced chronic kidney disease?
Cohort (n=20,352)
Yes
Does de novo statin use reduce infection-related hospitalization, major adverse cardiovascular events, and mortality in adults with non-dialysis advanced chronic kidney disease?
Hazard Ratio: 0.83 (95% CI 0.74–0.93)
Absolute Event Rate: 79.3% vs 94.3%
p-value: p=0.002
De novo statin use in patients with non-dialysis advanced chronic kidney disease (stage V) is associated with a significantly lower risk of major adverse cardiovascular events and infection-related hospitalizations.
Should not yet change statin prescribing in advanced CKD; leaves open need for RCTs to confirm infection benefit.
Background: Statins are commonly used for cardiovascular disease (CVD) prevention. Observational studies reported the effects on sepsis prevention and mortality improvement. Patients with chronic kidney disease (CKD) are at high risk for CVD and infectious diseases. Limited information is available for statin use in patients with non-dialysis CKD stage V. Method: The retrospective observational study included patients with non-dialysis CKD stage V, with either de novo statin use or none. Patients who were prior statin users and had prior cardiovascular events were excluded. The key outcomes were infection-related hospitalization, major adverse cardiovascular events (MACE) (non-fatal myocardial infarction, hospitalization for heart failure, or non-fatal stroke), and all-cause mortality. The data were retrieved from the Chang Gung Research Database (CGRD) from January 2001 to December 2019. Analyses were conducted with Cox proportional hazard regression models in the propensity score matching (PSM) cohort. Result: A total of 20,352 patients with CKD stage V were included (1,431 patients were defined as de novo statin users). After PSM, 1,318 statin users were compared with 1,318 statin non-users. The infection-related hospitalization (IRH) rate was 79.3 versus 94.3 per 1,000 person-years in statin users and statin non-users, respectively [hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.74–0.93, p = 0.002]. The incidence of MACE was 38.9 versus 55.9 per 1,000 person-years in statin users and non-users, respectively (HR, 0.72; 95% CI 0.62–0.83, p < 0.001). The all-cause mortality did not differ between statin users and non-users, but statin users had lower infection-related mortality than non-users (HR, 0.59; 95% CI 0.38–0.92, p = 0.019). Conclusion:De novo use of statin in patients with non-dialysis CKD stage V reduced the incidence of cardiovascular events, hospitalization, and mortality for infectious disease. The study results reinforced the benefits of statin in a wide range of patients with renal impairment before maintenance dialysis.
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Hsiao et al. (2022) conducted a cohort in Non-dialysis advanced chronic kidney disease (stage V) (n=20,352). De novo statin use vs. Statin non-users was evaluated on Infection-related hospitalization (HR 0.83, 95% CI 0.74-0.93, p=0.002). De novo statin use in patients with non-dialysis advanced chronic kidney disease was associated with a 17% lower risk of infection-related hospitalization compared to non-users (HR 0.83).
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