Statins In Dialysis-Dependent End-Stage Renal Disease: Reconciling Discordant Evidence Through GRADE-Informed Appraisal and Evidence-to-Decision Framework

In dialysis-dependent end-stage renal disease patients (ESRD), statin use remains an evidence-use dilemma: randomized controlled trials (RCTs) suggested limited benefit from statin initiation, whereas observational cohort studies reported lower mortality and cardiovascular events. This discordance creates uncertainty in prescribing, resource allocation, guideline interpretation, and shared decision-making. This analysis assessed whether this apparent conflict reflects true inconsistency, risk of bias, indirectness, or limitations in translating evidence into recommendations. Using narrative synthesis, GRADE-informed appraisal, and evidence-to-decision principles, an evidence-based, patient-centered approach is proposed based on the current available evidence.