Meta-analysis of statin therapy in maintenance dialysis patients

The effects of statin therapy in patients on maintenance dialysis remained uncertain. We conducted a meta-analysis to investigate the effects of statin on major clinical outcomes. We systematically searched Pubmed, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang and Chinese Technological Journal of Database for randomized controlled trials (RCTs). Criteria for inclusion were RCTs on statins therapy versus placebo, 43 months of follow-up. The outcomes were serum level of low density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), triglyceride (TG), high-sensitivity C-reactive protein (hs-CRP) and albumin (ALB), all cardiac events, cardiovascular deaths and all-cause mortality. Twenty-one trials were identified, providing data for 8186 patients on maintenance dialysis. Statin therapy reduced LDL-C (weighted mean difference [WMD] = -0.74 mmol/L; 95% CI [-0.96, -0.52], p<0.00001), TG (WMD = -0.36 mmol/L; 95% CI [-0.57, -0.14], p = 0.001), and hs-CRP (WMD = -3.98 mg/L; 95% CI [-5.24, -2.72], p<0.00001), elevated HDL-C (WMD = 0.25 mmol/L; 95% CI [0.10, 0.39], p = 0.0007) and ALB (WMD = 1.70 g/L; 95% CI [0.19, 3.21], p = 0.03) significantly comparing with placebo. Statin therapy also had benefit in reducing all cardiac events (relative risk [RR] = 0.90; 95% CI [0.83, 0.97], p = 0.006), but had no effect on cardiovascular deaths (RR = 0.97; 95% CI [0.88, 1.07], p = 0.54) or all-cause mortality (RR = 0.98; 95% CI [0.93, 1.04], p = 0.49). In conclusion, statins had no impact on allcause or cardiovascular mortality, while there was an overall significant improvement for dyslipidemia, hs-CRP, hypoalbuminemia and cardiovascular events in dialysis patients.