Ahmed A. Aly
University of Science, Malaysia (USM), Penang, Malaysia
Title: Statins, beyond lipids in Chronic kidney disease (CKD)
Biography
Biography: Ahmed A. Aly
Abstract
In the general population, beneficial effects of statin treatment on cardiovascular endpoints are well established. Chronic kidney disease (CKD) is a status of specific lipid disturbances, dyslipidemia with increased levels of triglycerides, small dense and oxidized LDL (oxLDL), and lower HDL cholesterol levels. In nephrotic syndrome, also total cholesterol and LDL levels are elevated. As patients with CKD and albuminuria have an increased incidence of cardiovascular disease, they should be considered for statin therapy. Currently, however, only 25% of CKD patients are under continuous statin therapy. The indirect and direct effects of lipids on glomerular structure have been described in detail in animal models of renal damage,as well as in patients. Therefore, in theory, beneficial systemic and renal effects of lipid-lowering in CKD by statins could be expected. In fact, there are indeed well-proven general effects of statins in CKD patients, lipid-lowering, anti-inflammatory and anti-oxidative effects.
In a post-hoc subgroup analysis of the CARE study, a randomized trial of pravastatin versus placebo in 4159 participants with previous myocardial infarction and total plasma cholesterol <240 mg/dL, a beneficial effect of statins on the loss of renal function in moderate CKD was found. Here, pravastatin reduced rates of renal loss to a greater extent in participants with than without proteinuria. A systematic meta-analysis found a small beneficial effect of statins on kidney function decline (particularly in patients with cardiovascular disease), and proteinuria.
The hereby analyzed studies, however, showed several limitations. Another meta-analysis using the data from randomized, placebo-controlled trials of statins reporting baseline and follow-up measurements of albuminuria or proteinuria found a reduction of albuminuria or proteinuria. A more recent meta-analysis also investigated the effects of statins in CKD patients and concluded with respect to potential renal effects: ‘Reno-protective effects of statins are uncertain because of relatively sparse data and possible outcomes reporting bias .