Dialysis – Transplantation
Kidney International (2002) 61, 297–304; doi:10.1046/j.1523-1755.2002.00109.x
HMG-CoA reductase inhibitors are associated with reduced mortality in ESRD patients
Stephen L Seliger, Noel S Weiss, Daniel L Gillen, Bryan Kestenbaum, Adrianne Ball, Donald J Sherrard and Catherine O Stehman-Breen
Division of Nephrology, University of Washington Medical Center; Department of Epidemiology and Department of Biostatistics, University of Washington School of Public Health; and Veterans Administration, Puget Sound Health Care System, Seattle, Washington, USA
Correspondence: Catherine Stehman-Breen, M.D., VA Puget Sound Health Care System, Mailstop 111A, 1650 S. Columbian Way, Seattle, Washington 98108, USA. E-mail: cos@u.washington.edu
Received 9 April 2001; Revised 7 August 2001; Accepted 16 August 2001.
Abstract
HMG-CoA reductase inhibitors are associated with reduced mortality in ESRD patients.
Background
Patients with end-stage renal disease (ESRD) suffer from markedly higher rates of cardiovascular disease than the general population. Although therapy with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors ("statins") has been demonstrated to reduce the mortality from cardiovascular disease in patients without ESRD, only 10% of patients on dialysis are treated with these medications by day 60 of ESRD. We determined whether the use of statins is associated with a reduction in cardiovascular-specific death and total mortality in ESRD patients.
Methods
Data were analyzed from the U.S. Renal Data System Dialysis Morbidity and Mortality Wave-2 study, a cohort of randomly selected patients who were initiating dialysis in 1996. Information about the use of statins as well as other baseline characteristics was abstracted from the patients' dialysis records by dialysis personnel. Cox proportional hazards models were developed to determine the association between use of statins at baseline and subsequent risk of mortality, with adjustment for known mortality risk factors.
Results
Follow-up data were available for 3716 patients through July 1998. At baseline, 362 (9.7%) of patients were using statins. These patients had a mortality rate of 143/1000 person-years, compared with a rate of 202/1000 person-years for patients not using statins. Statin use was independently associated with a reduced risk of total mortality [relative risk (RR) = 0.68, 95% confidence interval (CI) = 0.54, 0.87] as well as cardiovascular-specific mortality (RR = 0.64, 95% CI = 0.45, 0.91). In contrast, the use of fibrates was not associated with reduced mortality (RR = 1.29).
Conclusions
Statin use was associated with a reduction in cardiovascular-specific death and total mortality in patients on dialysis.
Keywords:
hypercholesterolemia, cardiovascular disease, end-stage renal disease, USRDS Wave 2, dialysis, blood pressure, lipoprotein
