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Statin initiation and risk of incident kidney disease in patients with diabetes

BACKGROUND: The role of statin therapy in the development of kidney disease in patients with type 2 diabetes mellitus (DM) remains uncertain. We aimed to determine the relationships between statin initiation and kidney outcomes in patients with type 2 DM. METHODS: Through a new-user design, we condu...

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Autores principales: Zhou, Shiyu, Su, Licong, Xu, Ruqi, Li, Yanqin, Chen, Ruixuan, Cao, Yue, Gao, Peiyan, Zhang, Xiaodong, Luo, Fan, Gao, Qi, An, Shengli, Cai, Wenyi, Lin, Lilong, Xu, Hong, Liu, Bicheng, Weng, Jianping, Chunbo, Chen, Liu, Huafeng, Yang, Qiongqiong, Li, Hua, Kong, Yaozhong, Li, Guisen, Wan, Qijun, Zha, Yan, Hu, Ying, Xu, Gang, Shi, Yongjun, Zhou, Yilun, Su, Guobin, Tang, Ying, Gong, Mengchun, Xu, Xin, Nie, Sheng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: CMA Impact Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10228577/
https://www.ncbi.nlm.nih.gov/pubmed/37247880
http://dx.doi.org/10.1503/cmaj.230093
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author Zhou, Shiyu
Su, Licong
Xu, Ruqi
Li, Yanqin
Chen, Ruixuan
Cao, Yue
Gao, Peiyan
Zhang, Xiaodong
Luo, Fan
Gao, Qi
An, Shengli
Cai, Wenyi
Lin, Lilong
Xu, Hong
Liu, Bicheng
Weng, Jianping
Chunbo, Chen
Liu, Huafeng
Yang, Qiongqiong
Li, Hua
Kong, Yaozhong
Li, Guisen
Wan, Qijun
Zha, Yan
Hu, Ying
Xu, Gang
Shi, Yongjun
Zhou, Yilun
Su, Guobin
Tang, Ying
Gong, Mengchun
Xu, Xin
Nie, Sheng
author_facet Zhou, Shiyu
Su, Licong
Xu, Ruqi
Li, Yanqin
Chen, Ruixuan
Cao, Yue
Gao, Peiyan
Zhang, Xiaodong
Luo, Fan
Gao, Qi
An, Shengli
Cai, Wenyi
Lin, Lilong
Xu, Hong
Liu, Bicheng
Weng, Jianping
Chunbo, Chen
Liu, Huafeng
Yang, Qiongqiong
Li, Hua
Kong, Yaozhong
Li, Guisen
Wan, Qijun
Zha, Yan
Hu, Ying
Xu, Gang
Shi, Yongjun
Zhou, Yilun
Su, Guobin
Tang, Ying
Gong, Mengchun
Xu, Xin
Nie, Sheng
author_sort Zhou, Shiyu
collection PubMed
description BACKGROUND: The role of statin therapy in the development of kidney disease in patients with type 2 diabetes mellitus (DM) remains uncertain. We aimed to determine the relationships between statin initiation and kidney outcomes in patients with type 2 DM. METHODS: Through a new-user design, we conducted a multicentre retrospective cohort study using the China Renal Data System database (which includes inpatient and outpatient data from 19 urban academic centres across China). We included patients with type 2 DM who were aged 40 years or older and admitted to hospital between Jan. 1, 2000, and May 26, 2021, and excluded those 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. The primary exposure was initiation of a statin. The primary outcome was the development of diabetic kidney disease (DKD), defined as a composite of the occurrence of kidney dysfunction (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m(2) 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 included development of kidney function decline (a sustained > 40% decline in eGFR). We used Cox proportional hazards regression 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. For statin initiators, we explored the association between different levels of lipid control and outcomes. We conducted analyses using propensity overlap weighting to balance the participant characteristics. RESULTS: Among 7272 statin initiators and 12 586 noninitiators in the weighted cohort, statin initiation was associated with lower risks of incident DKD (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.62–0.83) and kidney function decline (HR 0.60, 95% CI 0.44–0.81). We obtained similar results to 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 (HR 0.51, 95% CI 0.32–0.81) than those with inadequate lipid control (LDL-C ≥ 3.4 mmol/L). INTERPRETATION: For patients with type 2 DM admitted to and followed up in academic centres, statin initiation was associated with a lower risk of kidney disease development, particularly in those with intensive control of LDL-C. These findings suggest that statin initiation may be an effective and reasonable approach for preventing kidney disease in patients with type 2 DM.
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spelling pubmed-102285772023-05-31 Statin initiation and risk of incident kidney disease in patients with diabetes Zhou, Shiyu Su, Licong Xu, Ruqi Li, Yanqin Chen, Ruixuan Cao, Yue Gao, Peiyan Zhang, Xiaodong Luo, Fan Gao, Qi An, Shengli Cai, Wenyi Lin, Lilong Xu, Hong Liu, Bicheng Weng, Jianping Chunbo, Chen Liu, Huafeng Yang, Qiongqiong Li, Hua Kong, Yaozhong Li, Guisen Wan, Qijun Zha, Yan Hu, Ying Xu, Gang Shi, Yongjun Zhou, Yilun Su, Guobin Tang, Ying Gong, Mengchun Xu, Xin Nie, Sheng CMAJ Research BACKGROUND: The role of statin therapy in the development of kidney disease in patients with type 2 diabetes mellitus (DM) remains uncertain. We aimed to determine the relationships between statin initiation and kidney outcomes in patients with type 2 DM. METHODS: Through a new-user design, we conducted a multicentre retrospective cohort study using the China Renal Data System database (which includes inpatient and outpatient data from 19 urban academic centres across China). We included patients with type 2 DM who were aged 40 years or older and admitted to hospital between Jan. 1, 2000, and May 26, 2021, and excluded those 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. The primary exposure was initiation of a statin. The primary outcome was the development of diabetic kidney disease (DKD), defined as a composite of the occurrence of kidney dysfunction (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m(2) 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 included development of kidney function decline (a sustained > 40% decline in eGFR). We used Cox proportional hazards regression 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. For statin initiators, we explored the association between different levels of lipid control and outcomes. We conducted analyses using propensity overlap weighting to balance the participant characteristics. RESULTS: Among 7272 statin initiators and 12 586 noninitiators in the weighted cohort, statin initiation was associated with lower risks of incident DKD (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.62–0.83) and kidney function decline (HR 0.60, 95% CI 0.44–0.81). We obtained similar results to 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 (HR 0.51, 95% CI 0.32–0.81) than those with inadequate lipid control (LDL-C ≥ 3.4 mmol/L). INTERPRETATION: For patients with type 2 DM admitted to and followed up in academic centres, statin initiation was associated with a lower risk of kidney disease development, particularly in those with intensive control of LDL-C. These findings suggest that statin initiation may be an effective and reasonable approach for preventing kidney disease in patients with type 2 DM. CMA Impact Inc. 2023-05-29 2023-05-29 /pmc/articles/PMC10228577/ /pubmed/37247880 http://dx.doi.org/10.1503/cmaj.230093 Text en © 2023 CMA Impact Inc. or its licensors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Research
Zhou, Shiyu
Su, Licong
Xu, Ruqi
Li, Yanqin
Chen, Ruixuan
Cao, Yue
Gao, Peiyan
Zhang, Xiaodong
Luo, Fan
Gao, Qi
An, Shengli
Cai, Wenyi
Lin, Lilong
Xu, Hong
Liu, Bicheng
Weng, Jianping
Chunbo, Chen
Liu, Huafeng
Yang, Qiongqiong
Li, Hua
Kong, Yaozhong
Li, Guisen
Wan, Qijun
Zha, Yan
Hu, Ying
Xu, Gang
Shi, Yongjun
Zhou, Yilun
Su, Guobin
Tang, Ying
Gong, Mengchun
Xu, Xin
Nie, Sheng
Statin initiation and risk of incident kidney disease in patients with diabetes
title Statin initiation and risk of incident kidney disease in patients with diabetes
title_full Statin initiation and risk of incident kidney disease in patients with diabetes
title_fullStr Statin initiation and risk of incident kidney disease in patients with diabetes
title_full_unstemmed Statin initiation and risk of incident kidney disease in patients with diabetes
title_short Statin initiation and risk of incident kidney disease in patients with diabetes
title_sort statin initiation and risk of incident kidney disease in patients with diabetes
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10228577/
https://www.ncbi.nlm.nih.gov/pubmed/37247880
http://dx.doi.org/10.1503/cmaj.230093
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