Abstract 12517: Statin Therapy in Hemodialysis Patients improves Survival

Abstract

Background: Statin therapy has been shown to be beneficial in reducing cardiovascular events and improving survival in patients at high cardiovascular risk. End-stage renal disease (ESRD) patients are at very risk for CAD which remains the leading cause of death in these patients. While statin use in chronic kidney disease patients has shown some promise in randomized controlled trials, its use in ESRD patients receiving hemodialysis (HD) remains controversial.

Methods: We prospectively collected demographic, clinical, laboratory and pharmacological data on 442 consecutive ESRD patients on HD undergoing kidney transplant evaluation at our dedicated cardiology clinic. A decision to start or continue statin therapy was based upon patient risk profile, outcomes of stress test or coronary angiogram and fasting lipid panel. Survival analysis was performed as function of statin therapy.

Results: The baseline characteristics were: age 57+11 years, males 64%, hypertension 96%, diabetes 68%, dyslipidemia 58%, CAD 24%, left ventricular ejection fraction 61+11% . Lipid profile showed total cholesterol of 153+39 mg/dl, triglycerides 145+84 mg/dl, HDL 48+15 mg/dl, LDL 81+33 mg/dl and hsCRP 9.6+22.6. Over a period of two years, there were 41 deaths. Adjusted for age, diabetes, hyperlipidemia, smoking, treatment with ACEI, beta bloacher and antiplatelet medications, stain use was a predictor of lower mortality (HR 0.43, 95% CI 0.21-0.89, P = 0.02.Fig.1). This beneficial effect of statin was supported by propensity score analysis (p=0.02) and was prominently seen in subgroups with and without significant CAD, diabetics and those with hyperlipidemia

Conclusions: 1) Statin therapy in hemodialysis patients is independently associated with better survival. 2) The survival benefit is seen patients with and without significant CAD, in diabetics and those with hyperlipidemia. 3) Very high CRP as marker of intense inflammation does not seem to negate the benefit of statins.