MedicalResearch.com Interview with:
Elani Streja MPH PhD
Division of Nephrology and Hypertension
University of California, Irvine | UCI ·
Elvira O. Gosmanova, MD, FASN
Albany Stratton VA Medical Center
Csaba P Kovesdy MD
Fred Hatch Professor of Medicine
Division of Nephrology, University of Tennessee Health Science Center
Nephrology Section Chief, Memphis VA Medical Center
Director, Clinical Outcomes and Clinical Trials Program
Memphis TN, 38163
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Cardiovascular disease (CVD) is one of the leading causes of mortality and morbidity in patients with chronic kidney disease (CKD).
Statins are lipid-lowering drugs that have a proven track record in reducing risk of CVD in patients with advanced CKD who did not yet reach its terminal stage or end-stage renal disease (ESRD). Paradoxically, new prescription of statins after ESRD onset failed to reduce CVD related outcomes in three large clinical trials. However, benefits of statin continuation at transition from advanced CKD to ESRD was never formally tested.
Therefore, we identified a cohort of 14,298 US Veterans who used statins for at least half of the year during 1 year before ESRD transition and evaluated mortality outcomes based on whether statins were continued or stopped after ESRD onset.
We found that ESRD patients who continue statins for at least 6 months after transition had 28% and 18% lower risk of death from any cause or cardiovascular causes, respectively, during 12-months of follow up, as compared with statin discontinuers.
MedicalResearch.com: What should readers take away from your report?
Response: Ideally, a randomized clinical trial is needed to confirm current findings. Nevertheless, the conduction of such trial could be challenging from an ethical stand point due to emerging evidence that continuation of statins in the post-ESRD period could improve survival. Future studies are also needed to address benefits of continuation of other lipid-lowering drugs, such as fibrates and proprotein convertase subtilisin kexin 9 inhibitors in ESRD patients after transition dialysis.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Continuation of statin therapy from late CKD to post-ESRD period was associated with improved survival. Our findings fully support the current recommendations from the Kidney Disease Improving Global Outcomes (KDIGO) to continue statins after transition to dialysis if they were initiated in the pre-ESRD period.
Authors have no relevant disclosures.
Streja E, Gosmanova EO, Molnar MZ, et al. Association of Continuation of Statin Therapy Initiated Before Transition to Chronic Dialysis Therapy With Mortality After Dialysis Initiation. JAMA Network Open.2018;1(6):e182311. doi:10.1001/jamanetworkopen.2018.2311
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