Effect of statins on survival in patients undergoing dialysis access for end-stage renal disease

Autor: Basso Parente, Alessandra Manzone, Massimo Lenti, Paola De Rango, Gioele Simonte, Beatrice Fiorucci, Luca Farchioni, Selena Pelliccia, Enrico Cieri
Rok vydání: 2016
Předmět:
Aged
Aged
80 and over
Chi-Square Distribution
Female
Graft Occlusion
Vascular
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Kaplan-Meier Estimate
Kidney Failure
Chronic
Male
Middle Aged
Odds Ratio
Proportional Hazards Models
Protective Factors
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Vascular Patency
Renal Dialysis
Surgery
Cardiology and Cardiovascular Medicine
030204 cardiovascular system & hematology
Graft Occlusion
Kidney Failure
0302 clinical medicine
Hyperlipidemia
80 and over
Clinical endpoint
030212 general & internal medicine
Chronic
medicine.medical_specialty
Statin
medicine.drug_class
End stage renal disease
03 medical and health sciences
Vascular
Internal medicine
Diabetes mellitus
medicine
cardiovascular diseases
Proportional hazards model
business.industry
nutritional and metabolic diseases
Odds ratio
medicine.disease
business
Kidney disease
Zdroj: Seminars in Vascular Surgery. 29:198-205
ISSN: 0895-7967
Popis: The benefit of statin therapy in patients with advanced chronic kidney disease remains uncertain. Randomized trials have questioned the efficacy of the drug in improving outcomes for on-dialysis populations, and many patients with end-stage renal disease are not currently taking statins. This study aimed to investigate the impact of statin use on survival of patients with vascular access performed at a vascular center for chronic dialysis. Consecutive end-stage renal disease patients admitted for vascular access surgery in 2006 to 2013 were reviewed. Information on therapy was retrieved and patients on statins were compared to those who were not on statins. Primary endpoint was 5-year survival. Independent predictors of mortality were assessed with Cox regression analysis adjusting for covariates (ie, age, sex, hyperlipidemia, hypertension, cardiac disease, cerebrovascular disease, chronic obstructive pulmonary disease, obesity, diabetes, and statins). Three hundred fifty-nine patients (230 males; mean age 68.9 ± 13.7 years) receiving 554 vascular accesses were analyzed: 127 (35.4%) were on statins. Use of statins was more frequent in patients with hypertension (89.8% v 81%; P = .034), hyperlipidemia (52.4% v 6.2%; P < .0001), coronary disease (54.1% v 42.6%; P = .043), diabetes (39.4% v 21.6%; P = .001), and obesity (11.6% v 2.0%; P < .0001). Mean follow-up was 35 months. Kaplan-Meier survival rates at 3 and 5 years were 84.4% and 75.9% for patients taking statins and 77.0% and 65.1% for those not taking statins (P = .18). Cox regression analysis selected statins therapy as the only independent negative predictor (odds ratio = 0.55; 95% confidence interval = 0.32-0.95; P = .032) of mortality, while age was an independent positive predictor (odds ratio = 1.05; 95% confidence interval = 1.03-1.08; P < .0001). Vascular access patency was comparable in statin takers and those not taking statins (P = .60). Use of statins might halve the risk of all-cause mortality at 5 years in adult patients with vascular access for chronic dialysis. Statins therapy should be considered in end-stage renal disease populations requiring dialysis access placement.
Databáze: OpenAIRE
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