Comparative efficacy and choice of lipid-lowering drugs for cardiovascular and kidney outcomes in patients with chronic kidney disease: A systematic review and network meta-analysis
Open accessAbstract
BACKGROUND: The effect of exact classes of lipid-lowering drugs (LLDs) on preventing major adverse cardiovascular events (MACEs) and poor renal outcomes is not well characterized in the chronic kidney disease (CKD) population. METHODS: We performed a frequentist random-effects network meta-analysis of randomized controlled trials (RCTs) to evaluate the protective effect of the LLDs in non-dialysis CKD patients. The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched for relevant trials published before March 31, 2024. The primary outcome was the incidence of MACEs. The secondary outcomes comprised all-cause mortality, end-stage kidney disease, changes in estimated glomerular filtration rate (eGFR) and proteinuria, and safety. RESULTS: Forty-nine eligible RCTs with 77,826 participants with non-dialysis CKD were included. With moderate confidence in the evidence, rosuvastatin and atorvastatin showed statistically significantly more efficacy in reducing the risk of MACE, with a pooled risk ratio of 0.55 (95% CI 0.33-0.91) for rosuvastatin and 0.67 (0.49-0.90) for atorvastatin, respectively, compared with the control group. For the change in the eGFR, atorvastatin (mean difference [MD], 1.40; 95% CI, 0.61 to 2.18), rosuvastatin (MD, 1.73; 95% CI, 0.63 to 2.83), and statin plus ezetimibe (MD, 2.35; 95% CI, 0.44 to 4.26) showed statistically significant increases in the mean eGFR. CONCLUSION: In patients with non-dialysis CKD, there is sufficient evidence to show that rosuvastatin and atorvastatin were statistically significantly more effective and preferable in reducing the risk of MACE and increasing the mean eGFR compared with the control group.
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- Authors
- Lin, Y.-C., Lai, T.-S., Chen, Y.-T., Chou, Y.-H., Chen, Y.-M., Hung, K.-Y., & Tu, Y.-K.
- Affiliations
- National Taiwan University (TW)
- Venue
- Journal of the Formosan Medical Association
- Publisher
- Elsevier BV
- Published
- 2025-11
- Volume
- 124
- Issue
- 11
- Pages
- 1056-1064
- ISSN
- 0929-6646 (ISSN-L)
- OpenAlex
- W4403310280
- Semantic Scholar
- e117f172759ee0a5b6eee4c17a34a8b14b2fec7e
- Cited by
- 8
- References
- 56
- Citations by year
- 2026: 4 · 2025: 4
- FWCI
- 1.18
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of the Formosan Medical Association (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- National Taiwan University
- Ministry of Science and Technology, Taiwan (106-2314-B-002-098-MY3)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- lipid-lowering drugs, chronic kidney disease, predialysis, major adverse cardiovascular events, rosuvastatin, atorvastatin, statins, ezetimibe, estimated glomerular filtration rate, end-stage renal disease, proteinuria, all-cause mortality, drug safety
- MeSH terms
- Rosuvastatin Calcium, Atorvastatin, Ezetimibe, Network Meta-Analysis as Topic, Hypolipidemic Agents, Cardiovascular Diseases, Glomerular Filtration Rate, Humans, Kidney Failure, Chronic, Randomized Controlled Trials as Topic, Renal Insufficiency, Chronic
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