Open AccessStatin Therapy Before Transition to End‐Stage Renal Disease With Posttransition Outcomes
Author(s) -
Soohoo Melissa,
Moradi Hamid,
Obi Yoshitsugu,
Rhee Connie M.,
Gosmanova Elvira O.,
Molnar Miklos Z.,
Kashyap Moti L.,
Gillen Daniel L.,
Kovesdy Csaba P.,
KalantarZadeh Kamyar,
Streja Elani
Publication year - 2019
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.118.011869
Subject(s) - medicine , hazard ratio , dialysis , kidney disease , proportional hazards model , statin , end stage renal disease , cohort , incidence (geometry) , rate ratio , cohort study , disease , confidence interval , physics , optics
Background Although studies have shown that statin therapy in patients with non–dialysis‐dependent chronic kidney disease was associated with a lower risk of death, this was not observed in dialysis patients newly initiated on statins. It is unclear if statin therapy benefits administered during the predialysis period persist after transitioning to end‐stage renal disease. Methods and Results In 47 720 veterans who transitioned to end‐stage renal disease during 2007 to 2014, we examined the association of statin therapy use 1 year before transition with posttransition all‐cause and cardiovascular mortality and hospitalization incidence rates over the first 12 months of follow‐up. Associations were examined using multivariable adjusted Cox proportional hazard models and negative binomial regressions. Sensitivity analyses included propensity score and subgroup analyses. The cohort's mean± SD age was 71±11 years, and the cohort included 4% women, 23% blacks, and 66% diabetics. Over 12 months of follow‐up, there were 13 411 deaths, with an incidence rate of 35.3 (95% CI , 34.7–35.8) deaths per 100 person‐years. In adjusted models, statin therapy compared with no statin therapy was associated with lower risks of 12‐month all‐cause (hazard ratio [95% CI], 0.79 [0.76–0.82]) and cardiovascular (hazard ratio [95% CI ], 0.83 [0.78–0.88]) mortality, as well as with a lower rate of hospitalizations (incidence rate ratio [95% CI ], 0.89 [0.87–0.92]) after initiating dialysis. These lower outcome risks persisted across strata of clinical characteristics, and in propensity score analyses. Conclusions Among veterans with non–dialysis‐dependent chronic kidney disease, treatment with statin therapy within the 1 year before transitioning to end‐stage renal disease is associated with favorable early end‐stage renal disease outcomes.