Preventive Cardiology
Meta-Analysis of the Effect of Statins on Renal Function

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Statins can significantly improve the lipid profile and reduce cardiovascular events. However, beneficial effects of statins on renal function are still controversial. PubMed, the Cochrane Central Register of Controlled Trials, Web of Knowledge, and ClinicalTrials.gov Web sites were searched for randomized controlled trials. The selected studies reported renal function during treatment with statins and control. Forty-one studies with a total of 88,523 participants were included in this analysis. Compared with statins, placebo group had significantly decreased estimated glomerular filtration rate (eGFR): the standardized mean difference (SMD) of eGFR in change from baseline was 0.15 (95% confidence interval [CI] 0.07 to 0.23, p = 0.0004) in patients with eGFR >60 ml/min and 0.09 (95% CI 0.01 to 0.17, p = 0.02) in patients with eGFR 30 to 60 ml/min. Compared with placebo, statin group had significantly greater reduction of proteinuria: the SMD of proteinuria in change from baseline was −1.12 (95% CI −1.95 to −0.30, p = 0.008) in patients with urinary protein excretion 30 to 300 mg/day and −0.77 (95% CI −1.35 to −0.18, p = 0.01) in patients with urinary protein excretion > 300 mg/day. eGFR was significantly greater with high-intensity statins than with moderate-intensity statins (SMD 0.12, 95% CI 0.08 to 0.16, p = 0.00001). Placebo group had significantly decreased eGFR for 1 to 3 years (SMD 0.05, 95% CI 0.02 to 0.08, p = 0.003) and >3 years (SMD 0.14, 95% CI 0.04 to 0.25, p = 0.007) of statin therapy. The beneficial effect of statins on renal function may be dosage related and duration dependent. In conclusion, statins appear to decrease the rate of reduction of eGFR and slow the progression of pathologic proteinuria moderately.

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Methods

Our meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines.6 We searched the PubMed, the Cochrane Central Register of Controlled Trials, Web of Knowledge, and ClinicalTrials.gov Web sites to identify the published or unpublished randomized controlled trials (RCTs) in any language from 1987 to 2013. The following terms were used: hydroxymethylglutaryl-CoA reductase inhibitors, atorvastatin, simvastatin, rosuvastatin,

Results

Initially, 8,660 studies were searched, consisting of 366 potentially relevant studies and 8,294 studies that were removed after reading titles and abstracts. Of 366 potentially relevant studies, 325 failed to match the inclusion criteria. Finally, 41 studies with a total of 88,523 participants were included in this meta-analysis. Flowchart for identification of studies is presented in Figure 1. The baseline characteristics of studies in the meta-analysis are given in Table 1.

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Discussion

In our analysis, we identified 41 RCTs that assessed the effect of statins on kidney function and urinary protein excretion. In good agreement with previous findings,1, 4, 9 statins could reduce the decrease in eGFR for patients with stages 1 to 3 of CKD and decrease pathologic proteinuria moderately.

Most patients with CKD had mixed dyslipidemia, and mixed dyslipidemia could accelerate kidney function loss.12 The National Kidney Foundation regarded CKD as a cardiovascular disease risk

Acknowledgment

All authors had access to the data and participated in writing this manuscript.

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Drs. Geng and Ren contributed equally to this work.

This work was supported by the National Natural Science Foundation grant 30570712 and 81070179 funded by the national natural science fund committee (China).

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