Statin therapy is associated with improved survival in incident peritoneal dialysis patients: propensity-matched comparison

Abstract

BACKGROUND: Patients with end-stage renal disease (ESRD) have a greatly increased risk of premature cardiovascular disease. Peritoneal dialysis (PD) patients have more atherogenic lipid profiles than haemodialysis patients. In this retrospective cohort study, we evaluated whether statin use is associated with improved mortality in incident PD patients. METHODS: The study population included consecutive new PD patients (≥18 years old) from seven PD centres in Korea, between January 2003 and December 2008. The clinical outcome was mortality. A propensity score (PS) comprising demographic, clinical and laboratory variables was used to select a 1:1 matched cohort. RESULTS: Statins were prescribed for 37.8% of incident PD patients. Cumulative survival probabilities for statin user versus non-user were 87 versus 80% and 76 versus 69% at 3 and 5 years, respectively (P = 0.01). Statin prescription was associated with a 41% lower adjusted hazard ratio (HR) of death in the unmatched cohort [95% confidence interval (CI) = 0.42-0.82; P = 0.002]. The protective effect of statins was also observed in a subgroup analysis of patients with diabetic ESRD (HR = 0.53, 95% CI = 0.36-0.80; P = 0.002). After PS matching, the use of statins was also associated with improved survival (HR = 0.55, 95% CI = 0.38-0.79; P = 0.001) in incident PD patients. CONCLUSIONS: The use of statins was associated with a reduced risk of all-cause mortality. This association was independent of a history of cardiovascular disease or total cholesterol level. Future randomized clinical trials are warranted to confirm the beneficial effect of statin on PD patients.