Abstract: SA-PO1133
Comparative Mortality Risk Associated with Different Lipid-Lowering Therapies in Patients with Nondialysis-Dependent CKD
Session Information
- CKD: Progression, Drugs, Modalities, and Environmental Factors
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Naim, Mohammad Abdullah Al Zubair, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Streja, Elani, University of California Irvine, Irvine, California, United States
- Davis, Robert L., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Kalantar-Zadeh, Kamyar, VA Long Beach Healthcare System, Long Beach, California, United States
- Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background
The effect of different lipid-lowering therapies (LLTs) on mortality in patients with chronic kidney disease (CKD) is understudied. We examined the risk of cardiovascular (CV) death and all-cause mortality in patients with non-dialysis-dependent CKD initiating de-novo niacin and fibrate monotherapy vs. statin monotherapy.
Methods
We identified incident new users of fibrate (N=2,536), niacin (N=1,543), and statin (N=51,988) therapy in a nationwide cohort of 247,270 US Veterans with incident CKD at risk for de-novo LLT exposure. Patients were followed from the study entry until death, loss to follow-up, or end of the study (September 30, 2019). We used multivariable adjusted Cox-proportional hazards models to compare the associations of fibrate and niacin vs. statin use with CV death and all-cause mortality.
Results
Compared to statin users, patients initiating fibrate and niacin were younger with a higher baseline eGFR and triglyceride levels. Of 15,152 (event rate: 54.72/1000 PY; 95% CI, 53.85, 55.59) cases of all-cause deaths, a total of 4,281 patients (event rate: 19.54/1000 PY; 95% CI: 18.95, 20.12) experienced CV deaths, during a median follow-up time of 4.94 (IQR, 5.74) years. Unlike in unadjusted models, compared to statins, neither fibrate nor niacin use were significantly associated with lower mortality after multivariable adjustment (CV mortality, fibrate vs statin: adjusted HR: 0.85, [95% CI: 0.72, 1.01], p=0.065; niacin vs statin: 0.95 [0.81, 1.13], p=0.58; all-cause mortality, fibrate vs statin: 0.93 [0.86, 1.01], p=0.10; niacin vs statin: 0.98 [0.90, 1.07], p=0.64) (Table).
Conclusion
Neither fibrate nor niacin use is associated with significantly different CV and all-cause mortality when compared to statin use in patients with non-dialysis-dependent CKD. Further studies (including clinical trials) are needed to determine if fibrates or niacin can confer benefits over statins in this population.
Funding
- Veterans Affairs Support