Statin therapy in end-stage renal disease patients undergoing dialysis: A systematic review and meta-analysis

A BSTRACT Objectives: Cardiovascular disease is the leading cause of mortality in dialysis patients. While clinical trials have suggested uncertain benefit of statin therapy in this population, several large-scale observational studies have reported an association between statin use and reduced all-cause mortality. To further explore this issue, we aimed to assess the effectiveness of statin therapy in dialysis patients by synthesizing real-world data. Materials and Methods: We systematically searched PubMed and Embase for observational studies comparing adult statin users to nonusers in maintenance dialysis patients. Outcomes included all-cause mortality, cardiovascular death, stroke, myocardial infarction (MI), and major adverse cardiovascular events (MACE). Results: Nineteen studies with 310,370 dialysis patients were included. Statin use was associated with a lower risk of all-cause mortality (adjusted hazard ratio [aHR], 0.82; 95% confidence interval [CI], 0.77–0.87) and cardiovascular death (aHR, 0.83; 95% CI, 0.74–0.94). However, sensitivity analyses showed attenuated associations (aHR, 0.92; 95% CI, 0.89–0.96 for all-cause mortality; aHR, 0.90; 95% CI, 0.82–0.99 for cardiovascular death). No significant associations were observed between statin use and the risk of stroke, MI, or MACE. Conclusion: Statin therapy modestly reduced the risk of all-cause and cardiovascular mortality in patients undergoing maintenance dialysis but was not associated with a reduced risk of stroke, MI, or MACE.