Statin use is associated with lower cardiovascular death in patients undergoing dialysis who were renal transplant candidates
DOI:
https://doi.org/10.23925/1984-4840.2020v22i3a4Keywords:
falência renal crônica, transplante de rim, anticolesterolemiantes, inibidores de hidroximetilglutaril- CoA redutases, mortalidadeAbstract
Background: Cardiovascular (CV) diseases are major causes of mortality in renal transplant candidates. Objective: To evaluate the association between clinical and laboratorial variables, findings in coronary angiography and use of medicines with CV death in patients undergoing dialysis who were renal transplant candidates. Methods: An observational, longitudinal study was conducted in 103 renal transplant candidates from two transplant centers. The association between CV death and clinical variables was also investigated. Those variables that showed an association with the outcome variable at p<0,1 were selected for Cox analysis. Age and presence of diabetes mellitus were forced in the model. Results: We screened 128 patients, 20 of which were excluded because they refused to participate in the study and three died before the study started. Of the remaining 105 patients, two were excluded due to failures in the outcome records, so 103 were included in the longitudinal analysis. The univariate analysis did not identify the clinical variable that was associated with the occurrence of CV death. However, dialysis modality and statin use were selected for multiple analysis because they were associated with the outcome at p<0,1. Cox analysis to assess the association between clinical variables and the occurrence of CV death in dialysis patients only identified statin use as a predictor of lower risk of CV death (Hazard Ratio — HR=0,106, 95% confidence interval — 95%CI 0,013–0,852; p=0,035). Conclusion: In patients on dialysis who were candidates to renal transplantation only statin use showed an inverse, statistically significant association with the occurrence...
Downloads
Metrics
References
Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation.
;42(5):1050-65. https://doi.org/10.1161/01.HYP.0000102971.85504.7c
Lindley EM, Hall AK, Hess J, Abraham J, Smith B, Hopkins PN, et al. Cardiovascular risk assessment and management in prerenal transplantation candidates. Am J Cardiol. 2016;117(1):146-50. https://doi.org/10.1016/j.amjcard.2015.10.016
Seixas EA, Carmello BL, Kojima CA, Contti MM, Andrade LGM, Maiello JR, et al. Frequency and clinical predictors of coronary artery disease in chronic renal failure renal transplant candidates. Ren Fail. 2015;37(4):597-600. https://doi.org/10.3109/0886022X.2015.1007822
Hakeem A, Bhatti S, Chang SM. Screening and risk stratification of coronary artery disease in end-stage renal disease. J Am Coll Cardiol. 2014;7(7):715-28. https://doi.org/10.1016/j.jcmg.2013.12.015
Hage FG, Venkataraman R, Zoghbi GJ, Perry GJ, DeMattos AM, Iskandrian AE. The scope of coronary heart disease in patients with chronic kidney disease. J Am Coll Cardiol. 2009;53(23):2129-40. https://doi.org/10.1016/j.jacc.2009.02.047
Kerr M, Matthews B, Medcalf JF, O’Donoghue D. End-of-life care for people with chronic kidney disease: cause of death, place of death and hospital costs. Nephrol Dial Transplant. 2017;32(9):1504-9. https://doi.org/10.1093/ndt/gfw098
Stewart G, Jardine AG, Briggs JD. Ischaemic heart disease following renal transplantation. Nephrol Dial Transplant. 2000;15(2):269-77. https://doi.org/10.1093/ndt/15.2.269
Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation. American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119(14):e391-479. https://doi.org/10.1161/
CIRCULATIONAHA.109.192065
Bonow RO, Mann DL, Zipes DP. Braunwald tratado de doencas cardiovasculares. 9. ed. Rio de Janeiro: Saunders, Elsevier; 2013.
Lima JJ, Gowdak LH, Paula FJ, Muela HCS, David-Neto E, Bortolotto LA. Coronary artery disease assessment and intervention in renal transplant patients: analysis from the Kiheart Cohort. Transplantation. 2016;100(7):1580-7. https://doi.org/10.1097/TP.0000000000001157
Fellstrom BC, Jardine AG, Schmieder RE, Holdaas H, Bannister K, Beutler J, et al. AURORA Study Group. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis. N Engl J Med. 2009;360(14):1395-407. https://doi.org/10.1056/NEJMoa0810177
Wanner C, Krane V, Marz W, Olscheski M, Mann JFE, Ruf G, et al. German diabetes and dialysis study investigators. Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med. 2005;353(3):238-48. https://doi.org/10.1056/NEJMoa043545
Baigent C, Landray MJ, Reith C, Emberson J, Wheeler DC, Tomson C, et al. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet. 2011;377(9784):2181-92. https://doi.org/10.1016/S0140-6736(11)60739-3
Reinecke H, Breithardt G, Engelbertz C, Schmieder RE, Fobker M, Pinnschmidt HO, et al. Baseline characteristics and prescription patterns of standard drugs in patients with angiographically determined coronary artery disease and renal failure (CAD-REF Registry). PLoS One. 2016;11(2):e0148057. https://doi.org/10.1371/journal.pone.0148057
Strippoli GF, Navaneethan SD, Johnson DW, Perkovic V, Pellegrini F, Nicolucci A, et al. Effects of statins in patients with chronic kidney disease: meta-analysis and meta-regression of randomised controlled trials. BMJ. 2008;336(7645):645-51. https://doi.org/10.1136/bmj.39472.580984.AE
Palmer SC, Navaneethan SD, Craig JC, Johnson DW, Perkovic V, Hegbrant J, et al. HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis. Cochrane Database System Rev. 2014;(5):CD007784. https://doi.org/10.1002/14651858.CD007784.pub2
Lentine KL, Costa SP, Weir MR, Robb JF, Fleisher LA, Kasiske BL, et al. Cardiac disease evaluation and management among kidney and liver transplantation candidates: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. Circulation. 2012;126(5):617-63. https://doi.org/10.1161/CIR.0b013e31823eb07a
Cho EY, Myoung C, Park H-S, Kim AJ, Ro H, Chang JH, et al. Efficacy of statin treatment in early-stage chronic kidney disease. PLoS One. 2017;12(1):e0170017. https://doi.org/10.1371/journal.pone.0170017
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Revista da Faculdade de Ciências Médicas de Sorocaba
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Os autores no momento da submissão transferem os direitos autorais, assim, os manuscritos publicados passam a ser propriedade da revista.
O conteúdo do periódico está licenciado sob uma Licença Creative Commons 4.0, esta licença permite o livre acesso imediato ao trabalho e que qualquer usuário leia, baixe, copie, distribua, imprima, pesquise ou vincule aos textos completos dos artigos, rastreando-os para indexação, passá-los como dados para o software, ou usá-los para qualquer outra finalidade legal.
Este obra está licenciada com uma Licença 