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Chung CM, Lin MS, Hsu JT, Hsiao JF, Chang ST, Pan KL, Lin CL, Lin YS. Effects of statin therapy on cerebrovascular and renal outcomes in patients with predialysis advanced chronic kidney disease and dyslipidemia. J Clin Lipidol 2017; 11:422-431.e2. [PMID: 28502499 DOI: 10.1016/j.jacl.2017.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/02/2017] [Accepted: 01/02/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Treatment with statin may be beneficial for patients with chronic kidney disease (CKD). However, the debate over the clinical importance of statin in patients with predialysis advanced CKD remains unresolved. OBJECTIVES The objective of the article was to evaluate the effect of statin on mortality, cerebrovascular, and renal outcomes in patients with predialysis advanced CKD and dyslipidemia. METHODS Data on predialysis advanced CKD patients were retrieved from the National Health Insurance Research Database based on the guidelines for prescribing regular erythropoietin-stimulating agent in CKD patients. Patients with dyslipidemia were further selected and divided into 2 groups by their statin use after the prescribed erythropoietin-stimulating agent. All-cause mortality and cerebrovascular and renal outcomes were analyzed after propensity score matching. RESULTS There were 2016 and 14,412 patients in the statin and nonstatin groups. Their average follow-up periods were 3.7 and 3.0 years, respectively. After 1:2 propensity score matching, the annual all-cause mortality rate was higher in the nonstatin than in the statin group (143.99 vs 109.50 per 1000 person-years; P < .001; hazard ratio: 0.73; 95% confidence interval: 0.68-080). The annual risk of ischemic stroke (P = .186) and intracranial hemorrhage (P = .322) were not significantly different between the 2 groups. The nonstatin group had a higher risk of dialysis than the statin group (1269.45 vs 1095.00 per 1000 person-years; P = .002). Adverse events were not significant between the 2 groups. CONCLUSIONS Statins may reduce the all-cause mortality and reduced the risk of dialysis in patients with predialysis advanced CKD and dyslipidemia. However, statins have no impact on ischemic-hemorrhage stroke.
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Affiliation(s)
- Chang-Min Chung
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shyan Lin
- Division of Cardiology, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Jen-Te Hsu
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ju-Feng Hsiao
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Shih-Tai Chang
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuo-Li Pan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chun-Liang Lin
- Department of Nephrology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Sheng Lin
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
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Kujawa-Szewieczek A, Więcek A, Piecha G. The lipid story in chronic kidney disease: a long story with a happy end? Int Urol Nephrol 2014; 45:1273-87. [PMID: 23054316 PMCID: PMC3824376 DOI: 10.1007/s11255-012-0296-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cardiovascular (CV) morbidity and mortality increase with the severity of kidney disease, reaching 30 times higher mortality rates in dialysis patients compared with the general population. Although dyslipidemia is a well-established CV risk factor in the general population, the relationship between lipid disorders and CV risk in patients with chronic kidney disease (CKD) is less clear. Despite the clear evidence that statins reduce the risk of atherosclerotic events and death from cardiac causes in individuals without CKD, the use of statins in patients with kidney disease is significantly less frequent. For a long time, one of the explanations was the lack of a prospective, randomized, controlled study designed specifically to CKD patients. After recent publication of the data from Study of Heart and Renal Protection trial, given the safety and potential efficacy of statins, this lipid-lowering treatment should be administered more frequently to individuals with CKD stage 1–4, as well as those undergoing dialysis.
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Affiliation(s)
- Agata Kujawa-Szewieczek
- Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, ul. Francuska 20-24, 40-027, Katowice, Poland
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Ooba N, Sato T, Wakana A, Orii T, Kitamura M, Kokan A, Kurata H, Shimodozono Y, Matsui K, Yoshida H, Yamaguchi T, Kageyama S, Kubota K. A prospective stratified case-cohort study on statins and multiple adverse events in Japan. PLoS One 2014; 9:e96919. [PMID: 24810427 PMCID: PMC4014577 DOI: 10.1371/journal.pone.0096919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 03/13/2014] [Indexed: 12/05/2022] Open
Abstract
Purpose To assess the association between statins and diverse adverse events in Japanese population. Methods New users of statin who started statin after 6-month period of non-use were identified in 68 hospitals between January 2008 and July 2010. In addition to the random sample subcohort, we selected additional subcohort members to make the stratified sample subcohort have at least one patient in all subgroups stratified by each combination of statin and hospital. By abstraction from medical records, detailed information was obtained for all potential cases and pre-selected subcohort members. The event review committee consisting of 3 specialists judged whether possible cases met the definition of one of the adverse events of interest, and for adjudicated cases the committee further judged whether statin was a certain, probable or possible cause of the occurrence of the event. Adjusted for covariates including age, gender, status of “switcher”, use of high daily dose and comorbidities at baseline, hazard ratio (HR) was estimated by the Cox proportional hazards model with Barlow’s weighting method. Data were also analyzed by the method proposed by Breslow in 2009. Results A total of 6,877 new users of a statin were identified (median age: 66 years; males: 52%). The hazard ratios of increase in serum creatinine for atorvastatin and fluvastatin have wide confidence intervals, but both of the point estimates were around 2.5. Estimates of hazard ratios by the method of Barlow (1999) were similar to those by the method of Breslow (2009). Conclusions Use of statin was not associated with a significant increased risk for renal, liver and muscle events. However, the hazard ratio of increase in serum creatinine tended to be high with atorvastatin and fluvastatin to require further studies.
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Affiliation(s)
- Nobuhiro Ooba
- Department of Pharmacoepidemiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- * E-mail:
| | - Tsugumichi Sato
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba, Japan
- Drug Safety Research Unit Japan, Tokyo, Japan
| | | | | | - Masaki Kitamura
- Department of Pharmacy, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Hideaki Kurata
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshihiro Shimodozono
- Department of Clinical Pharmacy and Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kenichi Matsui
- Office for Promoting Medical Research, Showa University, Tokyo, Japan
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Takuhiro Yamaguchi
- Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Shigeru Kageyama
- Division of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine, Tokyo, Japan
| | - Kiyoshi Kubota
- Department of Pharmacoepidemiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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4
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Clinical assessment and management of dyslipidemia in patients with chronic kidney disease. Clin Exp Nephrol 2012; 16:522-9. [DOI: 10.1007/s10157-012-0655-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 05/31/2012] [Indexed: 11/25/2022]
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5
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Tullus K. Dyslipidemia in children with CKD: should we treat with statins? Pediatr Nephrol 2012; 27:357-62. [PMID: 21487766 DOI: 10.1007/s00467-011-1872-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 03/14/2011] [Accepted: 03/14/2011] [Indexed: 01/22/2023]
Abstract
Dyslipidemia has been shown to be a risk factor for increased cardiovascular morbidity and mortality in adult patients with chronic kidney disease (CKD) stages 2-4. In patients on dialysis, a paradoxical correlation has been found between low cholesterol values and increased mortality rates. No data exist in children. Treatment with statins has been convincingly shown to both reduce blood lipid levels and mortality rates from cardiovascular disease in adult patients in CKD stages 2-4. There is no strong literature support for treating patients on dialysis or after having had a transplant. Data on benefits of statin therapy do not exist in children with CKD. There are many differences between adult and paediatric kidney patients, and I caution on extrapolating the findings in adult patients to children. Studies are thus needed to evaluate the benefits and potential problems of statin treatment in children with CKD.
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Affiliation(s)
- Kjell Tullus
- Great Ormond Street Hospital for Children, Great Ormond Street, London, UK.
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Wang HT, Chen YL. The interaction between fluvastatin and warfarin. Int J Cardiol 2012; 155:167-8. [PMID: 21955611 DOI: 10.1016/j.ijcard.2011.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 09/05/2011] [Indexed: 01/22/2023]
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Shoji T, Abe T, Matsuo H, Egusa G, Yamasaki Y, Kashihara N, Shirai K, Kashiwagi A. Chronic kidney disease, dyslipidemia, and atherosclerosis. J Atheroscler Thromb 2011; 19:299-315. [PMID: 22166970 DOI: 10.5551/jat.10454] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Patients with chronic kidney disease (CKD) are at an increased risk not only for end-stage kidney disease (ESKD) but also for cardiovascular disease (CVD). In this review article, we summarize the current evidence of CKD as a high-risk condition for CVD based on reports from Japan and other countries to draw attention to the close clinical association between CKD and CVD. Several epidemiologic studies have shown that the presence of CKD and reduced renal function are independent predictors of CVD also in Japan. According to a post-hoc analysis of CASE-J, the power of CKD as a predictor of CVD is as strong as diabetes mellitus and a previous history of ischemic heart disease. CKD worsens classical risk factors including hypertension and dyslipidemia, and dyslipidemia is associated with increased thickness and stiffness of large arteries independent of major confounders. A post-hoc analysis of MEGA indicates that lipid-lowering therapy with statins reduces the risk of CVD, and that it appears to be more efficacious in patients with than without CKD. These reports from Japan and other countries suggest that CKD should be regarded as a high-risk condition comparable to diabetes mellitus, and that strict control of dyslipidemia would be beneficial in preventing CVD, at least early stages of CKD.
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Affiliation(s)
- Tetsuo Shoji
- Department of Geriatrics and Vascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Osaka, Japan.
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A meta-analysis of randomized trials for effects of atorvastatin on renal function in chronic kidney disease. Int J Cardiol 2011; 152:242-4. [PMID: 21764159 DOI: 10.1016/j.ijcard.2011.06.107] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 06/25/2011] [Indexed: 12/15/2022]
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Tsimihodimos V, Mitrogianni Z, Elisaf M. Dyslipidemia associated with chronic kidney disease. Open Cardiovasc Med J 2011; 5:41-8. [PMID: 21643500 PMCID: PMC3106357 DOI: 10.2174/1874192401105010041] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 01/06/2011] [Accepted: 01/06/2011] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular disease is a major cause of morbidity and mortality in patients with impaired renal function. Dyslipidemia has been established as a well-known traditional risk factor for cardiovascular disease (CVD) in the general population and it is well known that patients with chronic kidney disease (CKD) exhibit significant alterations in lipoprotein metabolism. In this review, the pathogenesis and treatment of CKD-induced dyslipidemia are discussed. Studies on lipid abnormalities in predialysis, hemodialysis and peritoneal dialysis patients are analyzed. In addition, the results of the studies that tested the effects of the hypolipidemic drugs on cardiovascular morbidity and mortality in patients with CKD are reported.
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Affiliation(s)
- Vasilis Tsimihodimos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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Itakura H, Nakaya N, Kusunoki T, Shimizu N, Hirai S, Mochizuki S, Ishikawa T. Long-term event monitoring study of fluvastatin in Japanese patients with hypercholesterolemia: Efficacy and incidence of cardiac and other events in elderly patients (≥65 years old). J Cardiol 2011; 57:77-88. [DOI: 10.1016/j.jjcc.2010.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 09/07/2010] [Accepted: 09/15/2010] [Indexed: 01/17/2023]
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12
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Holme I, Fayyad R, Faergeman O, Kastelein JJP, Olsson AG, Tikkanen MJ, Larsen ML, Lindahl C, Holdaas H, Pedersen TR. Cardiovascular outcomes and their relationships to lipoprotein components in patients with and without chronic kidney disease: results from the IDEAL trial. J Intern Med 2010; 267:567-75. [PMID: 20141566 DOI: 10.1111/j.1365-2796.2009.02176.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES In Incremental Decrease in Endpoints through Aggressive Lipid-lowering (IDEAL), we compared cardiovascular outcomes in patients with and without chronic kidney disease (CKD) (estimated glomerular filtration rate <60 mL min(-1) 1.73 m(-2)) and analysed relationships between lipoprotein components (LC) and major coronary events (MCE) and other cardiovascular (CV) events. DESIGN Exploratory analysis of CV endpoints in a randomized trial comparing high dose of atorvastatin to usual dose of simvastatin on MCE. SETTINGS Patients with CKD were compared with the non-CKD patients. Cox regression models were used to study the relationships between on-treatment levels of LC and incident MCE. FINDINGS Chronic kidney disease was strongly associated with cardiovascular end-points including total mortality. In patients with CKD, a significant benefit of high dose atorvastatin treatment was found for any CV events, stroke and peripheral artery disease, but not for MCE. However, all cardiovascular end-points except stroke and CV mortality were reduced in the non-CKD group. Differential changes in LC or relationships to LC could not explain the different treatment outcomes in MCE in the two groups. INTERPRETATION Chronic kidney disease was a powerful risk factor for all cardiovascular end-points. The reason why the significant reductions achieved by high-dose statin treatment in most CV end-points in the non-CKD group were only in part matched by similar reductions in the CKD patients is not apparent. This difference did not result from differential changes in or relations to LC, but limited power may have increased the possibility of chance findings.
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Affiliation(s)
- I Holme
- Oslo University Hospital, Ulleval, Centre of Preventive Medicine, Oslo, Norway.
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Resić H, Kukavica N, Sahović V, Masnić F. Different effects of low weight molecular heparin and unfractioned heparin on lipid profile and coagulation at haemodialysis patients. Bosn J Basic Med Sci 2010; 10 Suppl 1:S56-62. [PMID: 20433433 DOI: 10.17305/bjbms.2010.2650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Each haemodialysis treatment requires the application of anticoagulation medicines, which will prevent coagulation in extracorporal blood circulation. In this study we try to determine the quality of admitted anticoagulant and his effect on lipid profile on hemodialysis patients after twelve months. We were applying standard heparin and low weight molecular heparin (LWMH). During our study we was analyzed effect of anticoagulant therapy on lipid profile of hemodialysis patients. In that parameters was included triglycerides, cholesterol, lipoprotein fractions, complete blood count, Hgb, HCT; All of these parameters was analyzed in correlation with duration of hemodialysis treatment, sex and age of the patients. Our research was carried out as a prospective study, for the period of 12 months. In the study were included 60 patients (34M/26F), who were on chronic hemodialysis program. All patients were divided into two groups. The first group of patients was included 27 patients (15M/12F) who were treated with standard heparin. The second group was included 33 patients (19M/14F) treated with LWMH (enoxaparin). The average length of hemodialysis was 4.15 +/- 0.52 years. Each patient had a protocol in which is marked parameters such as flushing dialysator, creating fibrin-ring in vein and arterial dropper and the time it takes to stop the bleeding. In the results the average age amounted to 58.54 +/- 2.24 years. The average value of cholesterol in the blood was 5.38 +/- 2.26. Values of HDL-cholesterol in patients treated with LWMH were significantly lower (P<or=0.05) in the treated group compared to standard heparin. There were no significant statistical differences between both groups in relation to the level of LDL cholesterol in the blood. (p ns). LWMH had a better effect on the irrigation system and dialysator on both sex equally, compared with standard heparin. LWMH is in the female dialysis population has led to improvements in lipid profile. After the first six months of study in male patients treated with standard heparin in relation to the female part of the observed patients was significantly better anticoagulation effect in the first half of the study (1.85 +/- 0.05 compared to 2.09 +/- 0.10) (P<or=0.001). Average rating blood clots were statistically significant for standard heparin (p<or=0,001) with 1,86 at the beginning the value is fell to 1.41, while for LWMH with 1.85 at the beginning of the study amounted to 1.52 grade average. (P<or=0.05). The results of our study show that LWMH had a better rinsing effect of dialysis systems and dialysator in both sex equally, compared to standard unfractioned heparin. When the male part of the respondents in the first six months of standard heparin had a better evaluation of blood clots than women in the same group, and also better than the group on enoxaparin for both gender. LWMH in female dialysis population has led to improved lipid profiles. Patients treated with standard heparin had a statistically significant reduction in the rate of blood clots than patients who received enoxaparin (LWMH). Such differences were minimal, which can be interpreted by the fact that LWMH still derivative of the standard heparin.
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Affiliation(s)
- Halima Resić
- Clinic for Hemodialysis, University of Sarajevo Clinics Centre, Bolnicka 25, Sarajevo, Bosnia and Herzegovina
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Oda E, Kawai R. Low-density lipoprotein (LDL) cholesterol is cross-sectionally associated with preclinical chronic kidney disease (CKD) in Japanese men. Intern Med 2010; 49:713-9. [PMID: 20424360 DOI: 10.2169/internalmedicine.49.2792] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Low-density lipoprotein (LDL) cholesterol and chronic kidney disease (CKD) are both well-known risk factors for cardiovascular disease. However, few studies have examined the associations between LDL cholesterol and CKD. METHODS In the present study, we investigated the associations between LDL cholesterol and CKD using medical check-up data from 2,449 Japanese men and 1,448 Japanese women. Metabolic syndrome (MetS) was defined according to the revised National Cholesterol Education Program (NCEP) criteria for Japanese people. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) and/or proteinuria. RESULTS Blood levels of LDL cholesterol were higher in CKD subjects than in non-CKD subjects only in men and the frequency of antihyperlipidemic medication and MetS was higher in CKD subjects than in non-CKD subjects, regardless of gender. The frequency of CKD was significantly higher in male subjects with the highest quartile of LDL cholesterol than in those with the lowest quartile of LDL cholesterol. LDL cholesterol levels were significantly higher in subjects with eGFR corresponding to CKD stages 2 and 3 than in those with eGFR corresponding to CKD stage 1 both in men and women. LDL cholesterol was independently associated with CKD, eGFR <60 mL/min/1.73 m(2), and proteinuria in Japanese men, but not in women. CONCLUSION LDL cholesterol is cross-sectionally associated with preclinical CKD in Japanese men.
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Affiliation(s)
- Eiji Oda
- Medical Check-up Center, Tachikawa Medical Center.
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15
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Abstract
Chronic kidney disease may be stimulated by many different etiologies, but its progression involves a common, yet complex, series of events that lead to the replacement of normal tissue with scar. These events include altered physiology within the kidney leading to abnormal hemodynamics, chronic hypoxia, inflammation, cellular dysfunction, and activation of fibrogenic biochemical pathways. The end result is the replacement of normal structures with extracellular matrix. Treatments presently are focused on delaying or preventing such progression, and are largely nonspecific. In pediatrics, such therapy is complicated further by pathophysiological issues that render children a unique population.
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Bergrem H, Gøransson LG, Asmundsson P, Feldt-Rasmussen B, Grønhagen-Riska C, Westberg G. The Nephrocare project: Referral, patient case-mix, follow-up and quality of renal care in Nordic renal centres. ACTA ACUST UNITED AC 2009; 43:319-24. [DOI: 10.1080/00365590902833697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Harald Bergrem
- Department of Internal Medicine, Stavanger University Hospital, Norway
- Institute of Internal Medicine, University of Bergen, Norway
| | - Lasse G. Gøransson
- Department of Internal Medicine, Stavanger University Hospital, Norway
- Institute of Internal Medicine, University of Bergen, Norway
| | - Pall Asmundsson
- Department of Internal Medicine, Landspitallin, Reykjavik, Iceland
| | | | | | - Gunnar Westberg
- Department of Nephrology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Efficacy of simvastatin in children with hyperlipidemia secondary to kidney disorders. Pediatr Nephrol 2009; 24:1205-10. [PMID: 19238452 DOI: 10.1007/s00467-009-1128-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Revised: 12/11/2008] [Accepted: 12/12/2008] [Indexed: 10/21/2022]
Abstract
Children with hyperlipidemia secondary to renal disease develop premature atherosclerosis and glomerulosclerosis. The aims of this pilot study were to find the dosage and short-term efficacy of simvastatin and potential adverse events in children with chronic kidney diseases. This was a random, double-blind, placebo-controlled, cross-over clinical trial performed on children with hyperlipidemia secondary to kidney disorders. After being placed on a diet for 3 months, patients were randomly placed in one of two balanced group blocks and treated with diet plus placebo or simvastatin at doses of 5 mg for children weighing 30 kg or less and 10 mg for children weighing over 30 kg, for 1 month, and then doubled for two more months. After this treatment, patients were placed on a diet for a 3-month washout period. During the last trial phase, patients previously treated with simvastatin were administered a placebo, and vice versa. A total of 25 patients with ages ranging from 4 years to 17 years were included in the study. A significant decrease in the levels of serum cholesterol (26.4%), low-density lipoprotein (LDL) (35.4%) and triglycerides (23.1%) was noted during the study, primarily during the simvastatin treatments, in which case cholesterol, LDL and triglycerides decreased by 23.3%, 33.7% and 21%, respectively. High-density lipoprotein (HDL) levels increased moderately (10.7%) during the study but without differences during simvastatin treatment. No differences were found across groups with respect to adverse events. In the short-term the combination of diet and simvastatin was effective in lowering hyperlipidemia in children with renal disorders.
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Fellström B, Holdaas H, Jardine AG, Svensson MK, Gottlow M, Schmieder RE, Zannad F. Cardiovascular disease in patients with renal disease: the role of statins. Curr Med Res Opin 2009; 25:271-85. [PMID: 19210158 DOI: 10.1185/03007990802622064] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Atherosclerosis is common in patients with chronic kidney disease (CKD), and cardiovascular disease (CVD) represents a major cause of death. The National Kidney Foundation guidelines favour the use of statin therapy for treatment of dyslipidaemia in patients with CKD. Much evidence supports statin therapy for reducing CVD and improving outcomes in the general population, but there is less evidence in patients with CKD. Consequently, prevention of CVD in CKD is based primarily on extrapolation from non-CKD trials. Significantly, in trials specifically designed to investigate patients with CKD, evidence is emerging for improved cardiovascular outcomes with statin therapy. This review describes available data relating to cardiovascular outcomes and the role of statins in patients with CKD, including pre-dialysis, dialysis, and renal transplant patients. RESEARCH DESIGN AND METHODS The PubMed database was searched (1998-present) to ensure comprehensive identification of publications (including randomised clinical trials) relevant to CKD patients, patterns of cardiovascular outcome in such patients and their relationship to lipid profile, and the role of statins for the prevention and treatment of cardiovascular complications. RESULTS There are conflicting data on the relationship between dyslipidaemia and cardiovascular outcomes, with one major study of statin therapy (4D--Deutsche Diabetes Dialyse Studie) providing equivocal results. Further studies, including AURORA (A study to evaluate the Use of Rosuvastatin in subjects On Regular haemodialysis: an Assessment of survival and cardiovascular events; NCT00240331) in patients receiving haemodialysis, and SHARP (Study of Heart And Renal Protection; NCT00125593) in patients with CKD including those on dialysis, should help to clarify the role of statin therapy in these populations. CONCLUSIONS More studies are needed to elucidate the role of statins in improving cardiovascular outcomes for CKD patients. It is anticipated that ongoing clinical trials geared towards the optimal prevention and treatment of CVD in patients with CKD will help guide clinicians in the management of CKD.
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Affiliation(s)
- Bengt Fellström
- Department of Medical Science, Renal Unit, University Hospital, Uppsala, Sweden.
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McDonald KJ, Jardine AG. The use of fluvastatin in cardiovascular risk management. Expert Opin Pharmacother 2008; 9:1407-14. [PMID: 18473714 DOI: 10.1517/14656566.9.8.1407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Fluvastatin was the first synthetic 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) to be developed and is used in the management of dyslipidaemia in primary and secondary prevention of cardiovascular disease. OBJECTIVE This article reviews the properties of fluvastatin and experience accrued through its use in clinical practice and clinical trials. METHODS Relevant publications were identified through the PubMed database and product information held by the US Federal Drug Administration was also reviewed. RESULTS/CONCLUSIONS In the authors' opinion, fluvastatin exhibits a favourable safety profile in comparison to other statins, with a low incidence of adverse effects and a reduced propensity for interactions with other drugs. However, fluvastatin is a less potent cholesterol-lowering agent than newer statins on the market and its future predominant use is likely to be in niche patient groups at risk of side effects or drug interactions with other agents.
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Affiliation(s)
- Kenneth J McDonald
- University of Glasgow, BHF Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UK
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Wühl E, Schaefer F. Therapeutic strategies to slow chronic kidney disease progression. Pediatr Nephrol 2008; 23:705-16. [PMID: 18335252 PMCID: PMC2275772 DOI: 10.1007/s00467-008-0789-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 02/05/2008] [Accepted: 02/06/2008] [Indexed: 12/30/2022]
Abstract
Childhood chronic kidney disease commonly progresses toward end-stage renal failure, largely independent of the underlying disorder, once a critical impairment of renal function has occurred. Hypertension and proteinuria are the most important independent risk factors for renal disease progression. Therefore, current therapeutic strategies to prevent progression aim at controlling blood pressure and reducing urinary protein excretion. Renin-angiotensin-system (RAS) antagonists preserve kidney function not only by lowering blood pressure but also by their antiproteinuric, antifibrotic, and anti-inflammatory properties. Intensified blood pressure control, probably aiming for a target blood pressure below the 75th percentile, may exert additional renoprotective effects. Other factors contributing in a multifactorial manner to renal disease progression include dyslipidemia, anemia, and disorders of mineral metabolism. Measures to preserve renal function should therefore also comprise the maintenance of hemoglobin, serum lipid, and calcium-phosphorus ion product levels in the normal range.
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Affiliation(s)
- Elke Wühl
- Division of Pediatric Nephrology, University Hospital Heidelberg for Pediatric and Adolescent Medicine, Im Neuenheimer Feld 151, Heidelberg, Germany.
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