Analysis of risk factors in patients with severe chronic kidney disease. The role of atorvastatin.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Background and aim: There had been no randomized end-point studies with statins for patients with severe renal failure. The purpose of this prospective, open, randomized, controlled study was to investigate whether atorvastatin (10 mg/day) would alter cardiovascular end-points and the overall mortality rate of patients with chronic kidney disease stage 4 or 5 (creatinine clearance</30 ml/min) and to influence risk factors.
Material & Methods: This was an open, prospective, randomized study. A total of 143 patients were included: 73 were controls and 70 were prescribed 10 mg/day of atorvastatin. As efficacy variables, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglyceride levels were determined at the start of the study and at 1, 3, 6, 12, 18, 24, 30 and 36 months. The primary end-points were all cause of mortality, non-lethal acute myocardial infarction, and coronary artery intervention. Various risk factors were studied. In the 97 patients on haemodialysis inter dialysis weight gain (IDWG) was calculated as ultrafiltration in kg/body weight in kg given in percentage of the weight. The burden of IDWG was analyzed.
Results: In the atorvastatin group, total cholesterol and low-density lipoprotein cholesterol were significantly reduced, the latter by 35% at 1 month and then sustained. Atorvastatin was withdrawn in 23% of patients due to unacceptable side effects, most frequent complaints being gastrointestinal discomfort and headache. Primary end-points occurred in 74% of the subjects. There was no difference in cardiovascular endpoint and survival between the control and atorvastatin groups. The 5-year end-point-free survival rate from study entry was 20%. There was no evidence of more benefit of atorvastatin for patients with diabetes mellitus and chronic kidney disease versus the other patients; instead plasma fibrinogen increased. The IDWG was significantly larger in patients who suffered from end-points due to cardiovascular reasons, cardiac reasons, congestive heart failure, aortic aneurysm, and intracerebral bleeding.
Conclusion: These data showed that in contrast to other patient groups, patients with severe chronic kidney disease 4 and 5, including those with diabetes mellitus, seem to have no benefit from 10mg/day of atorvastatin. Instead we found a high IDWG to be an important risk factor that should be prevented. There was no evident connection between atorvastatin medication and IDWG.
Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2013. , 86 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1574
Atorvastatin, cholesterol, chronic kidney disease, haemodialysis, cholesterol, lipids, peritoneal dialysis, risk factors, statins, inter dialysis weight gain
IdentifiersURN: urn:nbn:se:umu:diva-68682ISBN: 978-91-7459-554-3OAI: oai:DiVA.org:umu-68682DiVA: diva2:617392
2013-05-30, Sal E04, by 6E, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Nilsson, Peter M, Professor
Stegmayr, Bernd G, ProfessorAndersson, Christer
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