Effect of Statins in Patients With Hemodialysis-Dependent Chronic Kidney Disease: A Nationwide Cohort Study

Abstract

Background Guidelines for lipid-lowering therapy in patients with dialysis-dependent chronic kidney disease remain ambiguous. We aimed to explore cardiovascular outcomes associated with statin use in patients with hemodialysis-dependent chronic kidney disease, stratified by prior statin use. Methods This was a retrospective cohort study of patients with chronic kidney disease who initiated maintenance hemodialysis, using a nationwide health claims database in Korea between 2010 and 2021. A multivariate Cox regression analysis was performed, incorporating statin use throughout the follow-up period as a time-dependent variable. The primary outcome was a composite of stroke, myocardial infarction, and all-cause mortality. A subgroup analysis was conducted based on statin use before hemodialysis initiation. Results Of the 49 868 study participants, the mean age at hemodialysis initiation was 65.5 +/- 11.2 years, and 32 225 (64.6%) were men. During a mean follow-up of 3.8 years, the primary composite outcome occurred in 20 345 patients (40.8%). Throughout the follow-up period, approximately 40% of patients received statin therapy. Statin use was significantly associated with a reduced risk of the primary composite outcome (adjusted hazard ratio, 0.51 [95% CI, 0.49-0.53]; P<0.001). This association was consistent regardless of prior statin use, although the benefit was less pronounced in statin-na & iuml;ve patients (P for interaction <0.001). Conclusions Statin use was consistently associated with improved long-term cardiovascular outcomes in patients with hemodialysis-dependent chronic kidney disease, regardless of prior statin use. These findings suggest that continuing statin therapy is crucial for cardiovascular prevention in patients already receiving statins before hemodialysis initiation; initiating statin therapy may also provide clinical benefits in statin-na & iuml;ve patients undergoing hemodialysis.