Statins improve limb salvage and CV risk in renal failure patients with PAD on dialysis: JAMA

TAIWAN: Patients on long-term maintenance dialysis with concurrent PAD and renal failure may benefit from statin medication in terms of protecting their cardiovascular systems and limbs, states a study published in JAMA Network.

It is estimated that more than 200 million people worldwide suffer from peripheral artery disease (PAD), which has become more common. The benefits of statin therapy for people with kidney failure are debatable, and it is especially unclear what statin therapy will do for those patients who also have peripheral artery disease (PAD) concurrent with their kidney failure.

The authors of the study aimed to assess the relationship between statin medication and cardiovascular (CV) and limb outcomes in patients undergoing long-term maintenance dialysis and having kidney failure with concurrent PAD and dyslipidemia.

10,767 of the 20,731 kidney failure patients with PAD and dyslipidemia who were diagnosed between January 1, 2001, and December 31, 2013, and were undergoing long-term maintenance dialysis, satisfied the study's eligibility requirements. Between June 8, 2021, and June 2, 2022, data were evaluated. Taiwan National Health Insurance Research Database information was used in this retrospective cohort analysis. All-cause mortality and a composite of endovascular treatment (EVT) and amputation were the main outcomes. Acute myocardial infarction, stroke, hospitalization for heart failure, major adverse limb events (new-onset claudication, new-onset critical limb ischemia, EVT, and nontraumatic amputation), and all-cause readmission were additional endpoints of interest. At the end of a year and a three-year follow-up, all results were evaluated.

Key findings of the research:

• At 3 years of follow-up, the statin group's incidence and risk of CV and all-cause death were significantly lower than the non-statin group's (CV death: 611 patients (18.9%) vs. 685 patients (21.2%); hazard ratio [HR], 0.86 [95% CI, 0.77-0.96]; P =.008; all-cause death: 1078 patients [33.3%] vs. 1138 patients [35.2%].
• The risk reduction associated with statin use increased in a dose-dependent manner in the adjusted dose-response analysis for both all-cause death and the composite outcome of EVT and amputation.
• Patients who underwent statin medication had a rate of the composite unfavourable limb outcome from endovascular therapy and amputation of 9.7%, while patients who did not, had a rate of 11.2%.

"Regardless of the type of dialysis, patient age or sex, or underlying comorbidities, statin medication in the current sample consistently provided positive results", added the authors.

The researchers concluded that the risk of death from any cause, death from cardiovascular disease, and the composite unfavourable limb outcome of EVT and amputation were all lower in patients on statin therapy.

REFERENCE

Lo H, Lin Y, Lin DS, Lee J, Chen W. Association of Statin Therapy With Major Adverse Cardiovascular and Limb Outcomes in Patients With End-stage Kidney Disease and Peripheral Artery Disease Receiving Maintenance Dialysis. JAMA Netw Open. 2022;5(9):e2229706. doi:10.1001/jamanetworkopen.2022.29706