Continuing statins through dialysis tied to better survival

  • Streja E & al.
  • JAMA Netw Open
  • 5 Oct 2018

  • curated by Yael Waknine
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Continuation of statin therapy after transition to dialysis is associated with significantly reduced all-cause and cardiovascular (CV) mortality.

Why this matters

  • Current guidelines advocate statin continuation, but clinical evidence is lacking; de novo use is not recommended.

Study design

  • Retrospective study of 14,298 US veterans (mean age, 71±10 years) receiving statins over the 1-year period before dialysis, surviving ≥1 year postdialysis.
  • 83.5% continued statins (≥6 months during dialysis) and 16.5% did not.
  • Participants were primarily males (96.7%) with diabetes (74.6%); 21.3% were African-American.
  • Funding: NIH, US Department of Veterans Affairs (VA).        

Key results

  • In the second year after dialysis initiation, 19.2% of patients died, 1.2% were censored for renal transplant, and 2.5% were lost to follow-up.
  • At 1 year posttransition, continued statin use yielded (per 100 person-years):
    • Fewer deaths vs nonuse (21.9 [95% CI, 20.9-22.8] vs 30.3 [95% CI, 27.8-32.8]).
    • Fewer CV deaths vs nonuse (8.1 [95% CI, 7.5-8.6] vs 9.8 [95% CI, 8.3-11.2]).
  • In adjusted analysis, continued statin use was tied to a 28% reduced risk for all-cause mortality (HR=0.72; 95% CI, 0.66-0.79) and 18% reduced risk for CV mortality (HR=0.82; 95% CI, 0.69-0.96).
  • Findings supported in subgroup analysis by age, race, and diabetes status.

Limitations

  • Observational design.
  • Reasons for statin discontinuation not captured.