Continuing statins through ESRD transition boosts survival

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Takeaway

  • Continuing statin therapy for ≥6 months after transition to dialysis is associated with reduced cardiovascular (CV) and all-cause mortality in the first year.

Why this matters

  • De novo statins offer no benefit in end-stage renal disease (ESRD), but continuing treatment started in advanced chronic kidney disease (CKD) could extend CV protection.

Study design

  • Cohort of 14,298 US veterans (mean age, 71 years; 96.7% male) receiving statins in the year before dialysis; 74.6% had diabetes and 21.3% were African-American.
  • 83.5% continued statins (≥6 months) and 16.5% did not.
  • Funding: NIH, U.S. Department of Veterans Affairs.    

Key results

  • In the year following transition, 19.2% of patients died, 1.2% were censored for kidney transplant, and 2.5% were lost to follow-up.
  • Statin continuation vs discontinuation was associated with reduced:
    • All-cause mortality (per 100 person-years [PY]: 21.9 [95% CI, 20.9-22.8] vs 30.3 [95% CI, 27.8-32.8]).
    • CV mortality (per 100 PY: 8.1 [95% CI, 7.5-8.6] vs 9.8 [95% CI, 8.3-11.2]).
  • In multivariate analysis, statin continuation was tied to a 28% lower risk for all-cause mortality (HR=0.72; 95% CI, 0.66-0.79) and 18% lower risk for CV mortality (HR=0.82; 95% CI, 0.69-0.96).
  • Effects were consistent regardless of age, race, and diabetic status.

Limitations

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