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Statin initiation and all-cause mortality in incident statin-naïve dialysis patients
Atherosclerosis ( IF 5.3 ) Pub Date : 2021-08-17 , DOI: 10.1016/j.atherosclerosis.2021.08.026
Ji Eun Kim 1 , Sehoon Park 2 , Myeong-Seok Kim 3 , Sung Jin Kang 3 , Jang Wook Lee 3 , Kwang Soo Kim 4 , Yong Chul Kim 5 , Dong Ki Kim 6 , Kwon Wook Joo 6 , Yon Su Kim 6 , Minsu Park 7 , Hajeong Lee 5
Affiliation  

Background and aims

Cardiovascular disease is the main cause of death in end-stage kidney disease (ESKD) patients. We aimed to explore the association between statin initiation after starting dialysis and all-cause mortality in statin-naïve ESKD patients.

Methods

We analyzed nationwide claims data of incident dialysis patients from 2010 to 2017 in South Korea. Patients who had previous cardiovascular events or were administered statins before dialysis were excluded. The study group included dialysis patients receiving statins within 1 year after dialysis initiation. The control group was organized after propensity-score matching with age, sex, era of dialysis initiation, and underlying diabetes mellitus and hypertension. The main outcomes were all-cause mortality and major cardiovascular events.

Results

We included 1596 patients who started statin treatment and 1:1 matched statin-nonusers. During the 9438 person-year follow-up, 468 deaths and 264 major adverse cardiovascular events (MACEs) occurred. Statin initiation was associated with a reduced risk of all-cause mortality (adjusted hazard ratio (aHR) 0.72, 95% confidence interval (CI) 0.60–0.87, p = 0.001), but not with MACE incidence (aHR 1.06, 95% CI 0.83–1.36, p = 0.62). In particular, patients prescribed the recommended dosage of statins according to the Kidney Disease Improving Global Outcomes guideline showed the lowest mortality risk (aHR 0.55, 95% CI 0.40–0.75, p < 0.001).

Conclusions

Statin initiation was associated with the lower risk of all-cause mortality in statin-naïve ESKD patients. As indication bias may be present in observational study setting, further prospective studies are warranted to validate the association of statin initiation and mortality in incident dialysis cases.



中文翻译:

未使用他汀类药物的透析患者中​​他汀类药物的使用和全因死亡率

背景和目标

心血管疾病是终末期肾病 (ESKD) 患者死亡的主要原因。我们旨在探讨他汀类药物初治 ESKD 患者开始透析后开始使用他汀类药物与全因死亡率之间的关联。

方法

我们分析了韩国 2010 年至 2017 年全国透析患者的索赔数据。排除既往有心血管事件或透析前服用他汀类药物的患者。研究组包括在透析开始后 1 年内接受他汀类药物治疗的透析患者。对照组是在与年龄、性别、透析开始时间以及潜在的糖尿病和高血压相匹配的倾向评分后组织的。主要结局是全因死亡率和主要心血管事件。

结果

我们纳入了 1596 名开始他汀类药物治疗的患者和 1:1 匹配的他汀类非使用者。在 9438 人年的随访期间,发生了 468 例死亡和 264 例主要不良心血管事件 (MACE)。他汀类药物启动与全因死亡风险降低相关(调整风险比 (aHR) 0.72,95% 置信区间 (CI) 0.60–0.87,p = 0.001),但与 MACE 发生率无关(aHR 1.06,95% CI 0.83–1.36,p = 0.62)。特别是,根据肾脏疾病改善全球结果指南规定推荐剂量的他汀类药物的患者显示出最低的死亡风险(aHR 0.55,95% CI 0.40–0.75,p  < 0.001)。

结论

在未使用他汀类药物的 ESKD 患者中,开始使用他汀类药物与较低的全因死亡风险相关。由于观察性研究环境中可能存在适应症偏倚,因此有必要进行进一步的前瞻性研究来验证事件透析病例中他汀类药物的使用与死亡率之间的关联。

更新日期:2021-08-17
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