Statins for improving renal outcomes: A meta-analysis
Statins for improving renal outcomes: A meta-analysis
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DOI：
10.1681/asn.2006010012
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发表时间：
2006-07-01
影响因子：
13.6
通讯作者：
Tonelli, Marcello
中科院分区：
文献类型：
--
作者：
Sandhu, Sabrina;Wiebe, Natasha;Tonelli, Marcello
统计学经常用于预防心血管事件。最近的几项研究表明，他汀类药物也可能对肾脏有益，尽管这是有争议的。本系统综述和荟萃分析旨在评估他汀类药物对肾功能和尿蛋白排泄变化的影响。检索Medline、EMBASE、对照试验的科克伦中心注册、会议记录和作者的个人档案。纳入了报告肾功能或蛋白尿评估的已发表或未发表的他汀类药物随机、对照试验或交叉试验，排除了ESRD患者的研究。提取研究设计、受试者特征、他汀类药物类型和剂量、基线/胆固醇水平变化和结局（测量或估计的GFR [eGFR]和/或尿蛋白排泄的变化）的数据。使用随机效应模型计算他汀类药物组和对照组之间GFR变化的加权平均差异。还使用随机效应模型计算组间尿蛋白排泄变化的标准化平均差异。确定了27项符合条件的研究，共39，704例受试者（21例有eGFR数据，20例有蛋白尿或白蛋白尿数据）。总体而言，eGFR的加权平均差异变化具有统计学显著性（他汀类药物接受者每年减慢1.22 nd/min; 95%置信区间[CI] 0.44至2.00）。在亚组分析中，他汀类药物治疗的获益在心血管疾病受试者的研究中具有统计学意义（比对照受试者慢0.93 ml/min/年; 95% CI 0.10 - 1.76），但在糖尿病或高血压肾病或肾小球肾炎受试者的研究中无统计学意义。他汀类药物治疗导致的白蛋白尿或蛋白尿减少的标准化平均差异具有统计学意义（他汀类药物接受者的SD增加0.58个单位; 95%CI 0.17 - 0.98）。他汀类药物治疗似乎可以适度减少蛋白尿，并导致肾功能丧失率的小幅降低，尤其是在心血管疾病人群中。
Statirts frequently are used to prevent cardiovascular events. Several recent studies suggest that statins also may have renal benefits, although this is controversial. This systematic review and meta-analysis were performed to assess the effect of statins on change in kidney function and urinary protein excretion. Medline, EMBASE, the Cochrane Central Register of Controlled Trials, conference proceedings, and the authors' personal files were searched. Published or unpublished randomized, controlled trials or crossover trials of statins that reported assessment of kidney function or proteirturia were included, and studies of individuals with ESRD were excluded. Data were extracted for study design, subject characteristics, type of statin and dose, baseline/change in cholesterol levels, and outcomes (change in measured or estimated GFR [eGFR] and/or urinary protein excretion). Weighted mean differences were calculated for the change in GFR between statin and control groups using a random-effects model. A random-effects model also was used to calculate the standardized mean difference for the change in urinary protein excretion between groups. Twenty-seven eligible studies with 39,704 participants (21 with data for eGFR and 20 for proteinuria or albuminuria) were identified. Overall, the change in the weighted mean differences for eGFR was statistically significant (1.22 nd/min per yr slower in statin recipients; 95% confidence interval [CI] 0.44 to 2.00). In subgroup analysis, the benefit of statin therapy was statistically significant in studies of participants with cardiovascular disease (0.93 ml/min per yr slower than control subjects; 95% CI 0.10 to 1.76) but was NS for studies of participants with diabetic or hypertensive kidney disease or glomerulonephritis. The standardized mean difference for the reduction in albuminuria or proteinuria as a result of statin therapy was statistically significant (0.58 units of SD greater in statin recipients; 95% CI 0.17 to 0.98). Statin therapy seems to reduce proteinuria modestly and results in a small reduction in the rate of kidney function loss, especially in populations with cardiovascular disease.