For eGFR decline we used the weighted mean difference (WMD) as measure for the pooled estimates. CK >10 x upper limit of normal6), Wanner, C. & Tonelli, M. KDIGO Clinical Practice Guideline for Lipid Management in CKD: summary of recommendation statements and clinical approach to the patient. Eur J Prev Cardiol 20, 658670 (2013). To obtain Sathasivam S, Lecky B. Statin induced . How do statins lower cholesterol? Discuss with your, . Finally, we found that the beneficial effect of statins on eGFR decline was weaker in RCTs with a higher mean systolic blood pressure. Merck Sharp & Dohme (New Zealand) Limited. Experimental evidence suggests that statin can prevent the progression of kidney injury [ 3 ]. Clin. Approaches to interpreting and choosing the best treatments in network meta-analyses. & Li, T. Network meta-analysis: an introduction for clinicians. ), effect estimates of all RCTs showed a protective effect of statin on eGFR decline53,62. We thus excluded 24 RCTs that reported only the outcome proteinuria (n=18), or that compared two statin interventions (n=6). substrates; fluvastatin and pravastatin are not7) The risk of myopathy may be increased by high doses of statins, especially in patients with co-morbidities, or in the presence of interacting medicines such as diltiazem. We used meta-regression to evaluate whether heterogeneity could be explained by age, sex, diabetes, blood pressure, baseline LDL, change in LDL, or risk of bias. Atherosclerosis 205, 202206 (2009). Creatinine is a natural byproduct of the breakdown of muscle tissue. erythromycin, J. Clin. Blinded resumption of statin therapy caused the weakness to recur. Systematic Reviews 2, 111 (2013). 5 months ago ggt was 90. what could be the cause for the increase? Eligible studies were randomized controlled trials (RCT) in adults (patients 18 years) with a follow-up duration of at least one year, that included at least 10 patients per trial arm, and reported on changes in eGFR and/or proteinuria. Correspondence to Dr Michael Tatley, New Zealand Pharmacovigilance Effect of high-dose atorvastatin on renal function in subjects with stroke or transient ischemic attack in the SPARCL trial. In pairwise meta-analyses, 1-year use of statins versus control reduced kidney function decline by 0.61 (95%-CI: 0.27; 0.95) mL/min/1.73m2 and proteinuria with a standardized mean difference of 0.58 (95%-CI:0.88; 0.29). Effect of lovastatin on primary prevention of cardiovascular events in mild CKD and kidney function loss: a post hoc analysis of the Air Force/Texas Coronary Atherosclerosis Prevention Study. "Statin-associated symptoms" (SAS) are favored by some over "statin intolerance" because many . & Arthur, J. M. Comparison of the Rate of Renal Function Decline in NonProteinuric Patients With and Without Diabetes. Impact of treatment of dyslipidemia on renal function, fat deposits and scarring in patients with persistent nephrotic syndrome. Since the average annual eGFR decline in adults with a history of cardiovascular disease is about 2mL/min/1.73m2, the reported effect of Kinouchi et al. Am. Effects are presented as standardized mean differences (SMD). Google Scholar. The possibility of an underlying metabolic vulnerability to this adverse effect of statins needs further exploration. Characteristics of included RCTs are shown in Table1. recently had their simvastatin dose increased to 60mg and 80mg daily. By using our website, you consent to our use of cookies. Wish you good health! Multiple meta-analyses studied the effect of statins on renal outcomes. After removing duplicate RCTs, 1303 titles and abstracts were screened for eligibility; 76 full publications were assessed. Taken together, these results suggest that a high systolic blood pressure modifies the effect of statins on eGFR decline. PubMed Central Focused atorvastatin therapy in managed-care patients with coronary heart disease and CKD. CKD Prevalence Varies across the European General Population. To reduce your creatinine levels permanently and improve your overall health, work with your doctor to find the underlying problem and remedy that. bezafibrate with pravastatin). J. Kidney Dis. All statistical analyses were performed using STATA Statistical Software version 14 (Statacorp, Texas, USA), and the StataNMA package26. On the other hand, larger compared to smaller RCTs showed a weak but opposite effect. Background: Although hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) are generally well tolerated, myopathy can be a serious adverse event. Ohsawa, M. et al. Drugs Aging 32, 10551065 (2015). Cholesterol-Lowering Treatment in Chronic Kidney Disease: Multistage Pairwise and Network Meta-Analyses, A systematic review and meta-analysis of the association between uric acid levels and chronic kidney disease, A systematic review and meta-analysis of the clinical impact of stopping reninangiotensin system inhibitor in patients with chronic kidney disease, Effect of Statins on Renal Function in Chronic Kidney Disease Patients, Clinical outcomes of renin angiotensin system inhibitor-based dual antihypertensive regimens in chronic kidney disease: a network meta-analysis, A systematic review and network meta-analysis of the comparative efficacy of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in hypertension, Effect of aspirin on primary prevention of cardiovascular disease and mortality among patients with chronic kidney disease, The efficacy and safety of immunosuppressive therapies in the treatment of IgA nephropathy: A network meta-analysis, http://creativecommons.org/licenses/by/4.0/, Systolic blood pressure, low-density lipoprotein cholesterol levels, and adverse kidney outcome: results from KNOW-CKD, Dyslipidemia, chronic kidney disease, atherosclerotic cardiovascular disease, and statins, Cardiovascular Risk in Patients with Chronic Kidney Disease with Special Reference to Statin Therapy, Beneficial effect of ACE inhibitors on kidney function in polycythemia vera, Association between lipid-lowering agents and severe hyponatremia: a population-based casecontrol study. Can statins cause memory loss? Effect of intensive lipid lowering with atorvastatin on renal function in patients with coronary heart disease: the Treating to New Targets (TNT) study. Esmeijer, K., Dekkers, O.M., de Fijter, J.W. Effects of pitavastatin add-on therapy on chronic kidney disease with albuminuria and dyslipidemia. Renal effects of atorvastatin and rosuvastatin in patients with diabetes who have progressive renal disease (PLANET I): a randomised clinical trial. Affiliation 1 Henry Low Heart Center, Department of Cardiology, Hartford Hospital, Connecticut, USA. Catapano, A. L. et al. failure. Fellstrom, B. et al. Globally, there was no evidence for inconsistency (p-value 0.8). Circ. Am. Soc. Network plots for the outcome eGFR decline (A) and proteinuria (B). Since only a small number of RCTs with small sample sizes studied the effect of statins on proteinuria, we could not perform the aforementioned sensitivity analyses. During the preliminary analysis of the first 21 patients enrolled, four patients were able to correctly identify statin therapy because of the recurrence of muscle symptoms. The validity of these comparisons may be limited, considering the clear differential effects of different dosages8,66. Transplant. Copyright 2023 American Academy of Family Physicians. However, it remains unclear whether specific types of statins are more beneficial than others regarding slowing down kidney function decline and lowering proteinuria. myopathy is suspected or diagnosed, immediate withdrawal of the statin is Circ. The FDA warns on statin labels that some people have developed memory loss or confusion while taking statins. Statistical heterogeneity was assessed by the I2-statistic, which quantifies the variation across studies due to heterogeneity rather than chance19. BMJ 315, 629634 (1997). Intern. Progression of kidney disease in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin versus usual care: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). in oct of 17 my tc was 317 ( ldl was 240) . CI, confidence interval; eGFR, estimated glomerular filtration rate; PrI, prediction interval. All patients Oesterle, A., Laufs, U. Use the Previous and Next buttons to navigate the slides or the slide controller buttons at the end to navigate through each slide. In the main analysis we compared change of eGFR or proteinuria after 12 months for statin users vs control treatment. This network meta-analysis has several limitations. J. ISSN 2045-2322 (online). Centre for Adverse Reactions Monitoring, Dunedin. 41, 565570 (2003). J. Hypertens. Many people with elevated cholesterol will require a statin in addition to diet. Effect of different types of statins on kidney function decline and proteinuria: a network meta-analysis. S1). However, this result was strongly influenced by the study of Kinouchi et al., comprising 54 patients, reporting an annual eGFR decline of 4.1mL/min/1.73m2 in patients treated with fluvastatin 20mg compared to an annual eGFR increase of 4.1mL/min/1.73m2 in patients treated with fluvastatin 20mg/ezetimibe 10mg46. Less serious myopathy symptoms, including fatigue, muscle pain, and weakness, occurring in patients with normal creatine kinase levels, may arise during treatment with a statin but will probably not lead to permanent muscle damage or chronic myopathy. These medications have also been linked to a lower risk of heart disease and stroke. The authors declare no competing interests. Diabetes Obes. 25, 18251833 (2014). Negative values mean a decrease in proteinuria for statin users vs non-users, thus favouring statin use. Fluvastatin 20mg/ezetimibe 10mg had the highest SUCRA value for eGFR decline (99%) and fluvastatin 20mg/ezetimibe 10mg (86%) as well as atorvastatin 4080mg (78%) had the highest SUCRA value for change in proteinuria (Fig. Various statins have different characteristics in terms of half-life, structure, lipophilicity, and potency9. The Cochrane Collaborations tool for assessing risk of bias in randomised trials. Heart Health Maintaining Heart Health More than 200 million people around the world take statin drugs for their heart health. Measure CK levels in patients who present with such symptoms. About The standard deviation (SD) of change was calculated using the SDs of eGFR or proteinuria at baseline and follow-up, according to the following formula12: where SD0 and SD1 represent the SD of baseline and follow-up, respectively, and Corr represents a correlation coefficient, which describes the similarity between baseline and follow-up measurements. Both had significant co-morbidity.8. Effects of Statins on Renal Function Patients with chronic kidney disease (CKD) are much more likely to die of cardiovascular disease than end-stage renal disease. Nonetheless, we repeated the network meta-analysis for eGFR decline excluding RCTs with a sample size <100 (n=16), excluding open-label RCTs (n=17), or excluding post-hoc analyses (n=20). Transplant. KDIGO Clinical Practice Guideline for Lipid Management in Chronic Kidney Disease. Scanferla, F., Toffoletto, P. P., Roncali, D. & Bazzato, G. Associated effect of hepatic hydroxymethylglutaryl coenzyme A reductase + angiotensin converting enzyme inhibitors on the progression of renal failure in hypertensive subjects. Centre, PO Box 913, Dunedin. J. Kidney Dis. This medication causes the body to retain more creatinine than you normally would. If a treatment always ranks first, the SUCRA is 100% (or 1), and 0% (or 0) if it always ranks last25. No language restrictions were imposed. Response.redirect "/searchResults.asp?q=" & q Dr. Loren Cohen answered Addiction Medicine 54 years experience Yes: While very uncommon, all of the statin drugs have been known to cause muscle injury. [1] Determining the renal function status can predict kidney disease progression and prevent toxic drug levels in the body. J. Outcomes 5, 25 (2012). Elevated ggt 115. normal for alt 27, ast 34 and alp 53. on statin for 1 year. Each connection was formed by maximally 4 RCTs. Less serious myopathy symptoms, including fatigue, muscle pain, and weakness, occurring in patients . is probably not useful in the absence of therapy changes or the development We tested for possible inconsistency globally using a 2-test, and locally by calculating inconsistency factors for each comparison in closed loops. May 2004, Dr Ruth Savage, Medical Assessor; Dr Michael Tatley, Director Am. Holme, I. et al. Hypertension is most likely a stronger risk factor for kidney function decline compared to hypercholesteremia. Cardiovascular outcomes and their relationships to lipoprotein components in patients with and without chronic kidney disease: results from the IDEAL trial. Sign up for the Nature Briefing newsletter what matters in science, free to your inbox daily. from initiation of, or change in, statin therapy. & Liao, J. K. Pleiotropic Effects of Statins on the Cardiovascular System. Zhou, Q. this Site | FAQs | Six of these Kimura, G. et al. never been elevated before. J. Kidney Dis. As a consequence we incorporated in our meta-analysis three extra RCTs, including the SHARP trial (n=5037). The results of the 12 month randomized, open comparative study. Normal levels Testing levels Causes Symptoms Contacting a doctor Treatments Outlook Summary High creatinine levels can indicate a range of underlying health conditions, including kidney. alternatives? 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