Introduction: Prior randomized control trials have suggested that statin use may be beneficial in non-dialysis dependent chronic kidney disease patients, but exhibits a lack of benefit for dialysis patients and that high dose statins have added benefit compared to moderate dose statins in patients with pre-existent heart disease. Yet, there is a paucity of data on whether high vs moderate dose statins initiated prior to transition to end-stage renal disease (ESRD) exhibit a benefit on post-ESRD survival.
Methods: We investigated a cohort of 21,104 US veterans on high or moderate dose statins for at least half of the one year prior to ESRD transition in 2007-2014. We examined the association of high vs moderate (ref.) dose statin use with early 6-month post-ESRD all-cause mortality after adjustment for demographics and comorbidities, including diabetes (DM) and atherosclerotic cardiovascular disease, and across subgroups.
Results: Patients were 72±10 years old, 3% female, and 75% diabetic. High dose statin patients composed 12.5% of the cohort, and had a lower crude 6-month death rate than moderate dose patients (31.4 vs 39.1 deaths per 100 person-years, respectively). Compared to moderate dose statin patients, high dose statin patients had better survival (HR[95%CI]: 0.90[0.81, 1.00]). This relationship was similar across all strata, and was particularly protective among patients with DM, and without ischemic heart disease, congestive heart failure, or prior myocardial infarction.
Conclusions: Incident ESRD patients on a high dose statin prior to transition have better post-ESRD transition survival compared to patients on a moderate dose. This was paradoxically evident among patients without pre-existing heart disease, thus possibly identifying patients where a high dose statin is beneficial prior to ESRD transition. Further studies are needed to investigate this relationship and examine the safety of high vs moderate dose statins in predialysis patients.