Abstract: FR-OR014

Continuation of Statin Therapy Initiated in Pre-ESRD Period and All-Cause and Cardiovascular Mortality after Transition to Dialysis

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Gosmanova, Elvira, Stratton VA Medical Center, Albany, New York, United States
  • Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Sumida, Keiichi, Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background

De novo statin therapy in ESRD patients failed to demonstrate significant cardiovascular (CV) protection in randomized clinical trials and, therefore, it is not recommended. However, whether continuation of statins from late-stages of non-dialysis dependent CKD to the post-ESRD period is associated with improved all-cause and CV mortality in dialysis patients is unknown.

Methods

We identified 14,939 US veterans transitioning to dialysis between 2007-2011 who were receiving statins during the 1 year prior to dialysis initiation and had adequate adherence, defined as proportion of days covered (PDC) of ≥80%. Subsequently, dialysis patients were characterized as statin continuers (N=5,066) if statin therapy was continued with PDC ≥80% during up to 1 year following dialysis initiation, and statin discontinuers (N=9,874) if statins were stopped or adherence to statins was inadequate (PDC <80%). Associations of statin continuation with all-cause and CV mortality following dialysis initiation was examined using Cox regressions adjusted for demographics, comorbidities, medications, and laboratory parameters.

Results

All-cause and CV mortality rates were 285 [95% CI 279-291]/1000 patient-years and 116 [95% CI 112-121]/1000 patient-years, respectively, during a mean ± SD 2.01±1.38 years of follow-up. Statin continuation after ESRD onset was associated with lower all-cause and CV mortality in unadjusted and various adjusted analyses (figure).

Conclusion

Extension of statin therapy following dialysis transition was associated with reduced all-cause and CV mortality. This data support experts’ opinion in the current lipid guidelines that statins started prior to dialysis should be continued after dialysis initiation.

Funding

  • NIDDK Support