Among T2 Diabetes patients with Poorly Controlled Lipid Levels, Early Statin Initiation reduces Renal disease risk
Recent research revealed that early initiation of statins effectively reduces the risk of renal disease in T2 diabetics who are at risk of developing renal disease and need immense control of lipoproteins. The study was published in the Canadian Medical Association Journal.
Diabetic kidney disease (DKD) is a common microvascular complication in patients with type 2 diabetes causing an enormous burden physically and financially. Dyslipidemia is one of the risk factors for diabetic kidney disease. Statins are the most common medications that reduce the cardiovascular risk in patients with type 2 diabetes and hypertension. Though guidelines recommend the use of statins for diabetic patients who are 40 years or older, some literature has shown worsening glycemic control progressing the microvascular diseases. As there is uncertainty about prescribing statins for diabetic kidney disease, researchers conducted a multicentre retrospective cohort study to determine the relationships between statin initiation and kidney outcomes in patients with type 2 DM.
Using a new-user design from the China Renal Data System database, patients with type 2 DM who were aged 40 years or older and admitted to the hospital between Jan. 1, 2000, and May 26, 2021, were included. Any patients with pre-existing chronic kidney disease and those who were already on statins or without follow-up at an affiliated outpatient clinic within 90 days after discharge were excluded. The primary exposure was the initiation of a statin.
The outcomes of the measurements were:
| Primary outcome - | occurrence of kidney dysfunction estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2 and > 25% decline from baseline) and |
| proteinuria (a urinary albumin-to-creatinine ratio ≥ 30 mg/g and > 50% increase from baseline), sustained for at least 90 days | |
| secondary outcomes | development of kidney function decline (a sustained > 40% decline in eGFR) |
Cox proportional hazards regression was used to evaluate the relationships between statin initiation and kidney outcomes, as well as to conduct subgroup analyses according to patient characteristics, presence or absence of dyslipidemia, and pattern of dyslipidemia. The association between different levels of lipid control and outcomes was explored for statin initiators. Analyses were conducted using propensity overlap weighting to balance the participant characteristics.
Key findings:
- Among 7272 statin initiators and 12,586 non initiators in the weighted cohort, statin initiation was associated with lower risks of incident DKD and kidney function decline.
- Similar results were obtained in the primary analyses for participants with differing patterns of dyslipidemia, those prescribed different statins, and after stratification according to participant characteristics.
- Among statin initiators, those with intensive control of high-density lipoprotein cholesterol (LDL-C) (< 1.8 mmol/L) had a lower risk of incident DKD than those with inadequate lipid control (LDL-C ≥ 3.4 mmol/L).
Thus, statin initiation was associated with significantly lower risks of developing DKD and kidney function decline. These relationships were strong and unaffected by variations in clinical traits or dyslipidemia patterns.
Further reading: Shiyu Zhou et al. Statin initiation and risk of incident kidney disease in patients with diabetes. https://doi.org/10.1503/cmaj.230093
