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Statins CKD benefit only in those with heart risk

Statins are only beneficial for patients with chronic kidney disease if they are at a particularly high cardiovascular risk, say Cochrane researchers.

A meta-analysis of 50 trials found a 20% reduction in cardiovascular mortality and non-fatal cardiovascular events with statins in people with all stages of CKD – roughly in line with the effect seen in other patients.

But there was no reduction in all-cause mortality in CKD patients treated with statins, and the researchers said the evidence of benefit was unclear in CKD patients whose cardiovascular risk was relatively low.

The research questions the benefit for mass treatment of patients with CKD under the QOF, with the researchers calling for results to be collated from ongoing trials to clarify the role of statins in primary prevention in CKD patients.

But the analysis did find statins were safe, with low rates of major side effects such as hepatotoxicity and rhabdomyolysis, and little treatment withdrawal.

Writing in the BMJ, the Australian reviewers said the findings provided support for widespread use of statins in people with CKD who had established coronary artery disease or ischaemic cerebrovascular disease, but that ‘the effects of treatment in people at lower absolute risk and the effects on total mortality remain to be defined.'

In an accompanying editorial, Dr Catherine Clase, associate professor of medicine at McMaster University in Ontario, Canada, said that until we knww more, the criteria for initiating a statin in CKD should be the same as in everybody else.


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