Statin Therapy Before Transition to End-Stage Renal Disease With Posttransition Outcomes

Melissa Soohoo, Hamid Moradi, Yoshitsugu Obi, Connie M. Rhee, Elvira O. Gosmanova, Miklos Z. Molnar, Moti L. Kashyap, Daniel L. Gillen, Csaba Kovesdy, Kamyar Kalantar-Zadeh, Elani Streja

Research output: Contribution to journalArticle

Abstract

Background: Although studies have shown that statin therapy in patients with non–dialysis-dependent chronic kidney disease was associated with a lower risk of death, this was not observed in dialysis patients newly initiated on statins. It is unclear if statin therapy benefits administered during the predialysis period persist after transitioning to end-stage renal disease. Methods and Results: In 47 720 veterans who transitioned to end-stage renal disease during 2007 to 2014, we examined the association of statin therapy use 1 year before transition with posttransition all-cause and cardiovascular mortality and hospitalization incidence rates over the first 12 months of follow-up. Associations were examined using multivariable adjusted Cox proportional hazard models and negative binomial regressions. Sensitivity analyses included propensity score and subgroup analyses. The cohort's mean±SD age was 71±11 years, and the cohort included 4% women, 23% blacks, and 66% diabetics. Over 12 months of follow-up, there were 13 411 deaths, with an incidence rate of 35.3 (95% CI, 34.7–35.8) deaths per 100 person-years. In adjusted models, statin therapy compared with no statin therapy was associated with lower risks of 12-month all-cause (hazard ratio [95% CI], 0.79 [0.76–0.82]) and cardiovascular (hazard ratio [95% CI], 0.83 [0.78–0.88]) mortality, as well as with a lower rate of hospitalizations (incidence rate ratio [95% CI], 0.89 [0.87–0.92]) after initiating dialysis. These lower outcome risks persisted across strata of clinical characteristics, and in propensity score analyses. Conclusions: Among veterans with non–dialysis-dependent chronic kidney disease, treatment with statin therapy within the 1 year before transitioning to end-stage renal disease is associated with favorable early end-stage renal disease outcomes.

Original languageEnglish (US)
Article numbere011869
JournalJournal of the American Heart Association
Volume8
Issue number6
DOIs
StatePublished - Mar 19 2019

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Chronic Kidney Failure
Propensity Score
Veterans
Chronic Renal Insufficiency
Therapeutics
Dialysis
Incidence
Hospitalization
Mortality
Proportional Hazards Models

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Soohoo, M., Moradi, H., Obi, Y., Rhee, C. M., Gosmanova, E. O., Molnar, M. Z., ... Streja, E. (2019). Statin Therapy Before Transition to End-Stage Renal Disease With Posttransition Outcomes. Journal of the American Heart Association, 8(6), [e011869]. https://doi.org/10.1161/JAHA.118.011869

Statin Therapy Before Transition to End-Stage Renal Disease With Posttransition Outcomes. / Soohoo, Melissa; Moradi, Hamid; Obi, Yoshitsugu; Rhee, Connie M.; Gosmanova, Elvira O.; Molnar, Miklos Z.; Kashyap, Moti L.; Gillen, Daniel L.; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar; Streja, Elani.

In: Journal of the American Heart Association, Vol. 8, No. 6, e011869, 19.03.2019.

Research output: Contribution to journalArticle

Soohoo, M, Moradi, H, Obi, Y, Rhee, CM, Gosmanova, EO, Molnar, MZ, Kashyap, ML, Gillen, DL, Kovesdy, C, Kalantar-Zadeh, K & Streja, E 2019, 'Statin Therapy Before Transition to End-Stage Renal Disease With Posttransition Outcomes', Journal of the American Heart Association, vol. 8, no. 6, e011869. https://doi.org/10.1161/JAHA.118.011869
Soohoo, Melissa ; Moradi, Hamid ; Obi, Yoshitsugu ; Rhee, Connie M. ; Gosmanova, Elvira O. ; Molnar, Miklos Z. ; Kashyap, Moti L. ; Gillen, Daniel L. ; Kovesdy, Csaba ; Kalantar-Zadeh, Kamyar ; Streja, Elani. / Statin Therapy Before Transition to End-Stage Renal Disease With Posttransition Outcomes. In: Journal of the American Heart Association. 2019 ; Vol. 8, No. 6.
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abstract = "Background: Although studies have shown that statin therapy in patients with non–dialysis-dependent chronic kidney disease was associated with a lower risk of death, this was not observed in dialysis patients newly initiated on statins. It is unclear if statin therapy benefits administered during the predialysis period persist after transitioning to end-stage renal disease. Methods and Results: In 47 720 veterans who transitioned to end-stage renal disease during 2007 to 2014, we examined the association of statin therapy use 1 year before transition with posttransition all-cause and cardiovascular mortality and hospitalization incidence rates over the first 12 months of follow-up. Associations were examined using multivariable adjusted Cox proportional hazard models and negative binomial regressions. Sensitivity analyses included propensity score and subgroup analyses. The cohort's mean±SD age was 71±11 years, and the cohort included 4{\%} women, 23{\%} blacks, and 66{\%} diabetics. Over 12 months of follow-up, there were 13 411 deaths, with an incidence rate of 35.3 (95{\%} CI, 34.7–35.8) deaths per 100 person-years. In adjusted models, statin therapy compared with no statin therapy was associated with lower risks of 12-month all-cause (hazard ratio [95{\%} CI], 0.79 [0.76–0.82]) and cardiovascular (hazard ratio [95{\%} CI], 0.83 [0.78–0.88]) mortality, as well as with a lower rate of hospitalizations (incidence rate ratio [95{\%} CI], 0.89 [0.87–0.92]) after initiating dialysis. These lower outcome risks persisted across strata of clinical characteristics, and in propensity score analyses. Conclusions: Among veterans with non–dialysis-dependent chronic kidney disease, treatment with statin therapy within the 1 year before transitioning to end-stage renal disease is associated with favorable early end-stage renal disease outcomes.",
author = "Melissa Soohoo and Hamid Moradi and Yoshitsugu Obi and Rhee, {Connie M.} and Gosmanova, {Elvira O.} and Molnar, {Miklos Z.} and Kashyap, {Moti L.} and Gillen, {Daniel L.} and Csaba Kovesdy and Kamyar Kalantar-Zadeh and Elani Streja",
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T1 - Statin Therapy Before Transition to End-Stage Renal Disease With Posttransition Outcomes

AU - Soohoo, Melissa

AU - Moradi, Hamid

AU - Obi, Yoshitsugu

AU - Rhee, Connie M.

AU - Gosmanova, Elvira O.

AU - Molnar, Miklos Z.

AU - Kashyap, Moti L.

AU - Gillen, Daniel L.

AU - Kovesdy, Csaba

AU - Kalantar-Zadeh, Kamyar

AU - Streja, Elani

PY - 2019/3/19

Y1 - 2019/3/19

N2 - Background: Although studies have shown that statin therapy in patients with non–dialysis-dependent chronic kidney disease was associated with a lower risk of death, this was not observed in dialysis patients newly initiated on statins. It is unclear if statin therapy benefits administered during the predialysis period persist after transitioning to end-stage renal disease. Methods and Results: In 47 720 veterans who transitioned to end-stage renal disease during 2007 to 2014, we examined the association of statin therapy use 1 year before transition with posttransition all-cause and cardiovascular mortality and hospitalization incidence rates over the first 12 months of follow-up. Associations were examined using multivariable adjusted Cox proportional hazard models and negative binomial regressions. Sensitivity analyses included propensity score and subgroup analyses. The cohort's mean±SD age was 71±11 years, and the cohort included 4% women, 23% blacks, and 66% diabetics. Over 12 months of follow-up, there were 13 411 deaths, with an incidence rate of 35.3 (95% CI, 34.7–35.8) deaths per 100 person-years. In adjusted models, statin therapy compared with no statin therapy was associated with lower risks of 12-month all-cause (hazard ratio [95% CI], 0.79 [0.76–0.82]) and cardiovascular (hazard ratio [95% CI], 0.83 [0.78–0.88]) mortality, as well as with a lower rate of hospitalizations (incidence rate ratio [95% CI], 0.89 [0.87–0.92]) after initiating dialysis. These lower outcome risks persisted across strata of clinical characteristics, and in propensity score analyses. Conclusions: Among veterans with non–dialysis-dependent chronic kidney disease, treatment with statin therapy within the 1 year before transitioning to end-stage renal disease is associated with favorable early end-stage renal disease outcomes.

AB - Background: Although studies have shown that statin therapy in patients with non–dialysis-dependent chronic kidney disease was associated with a lower risk of death, this was not observed in dialysis patients newly initiated on statins. It is unclear if statin therapy benefits administered during the predialysis period persist after transitioning to end-stage renal disease. Methods and Results: In 47 720 veterans who transitioned to end-stage renal disease during 2007 to 2014, we examined the association of statin therapy use 1 year before transition with posttransition all-cause and cardiovascular mortality and hospitalization incidence rates over the first 12 months of follow-up. Associations were examined using multivariable adjusted Cox proportional hazard models and negative binomial regressions. Sensitivity analyses included propensity score and subgroup analyses. The cohort's mean±SD age was 71±11 years, and the cohort included 4% women, 23% blacks, and 66% diabetics. Over 12 months of follow-up, there were 13 411 deaths, with an incidence rate of 35.3 (95% CI, 34.7–35.8) deaths per 100 person-years. In adjusted models, statin therapy compared with no statin therapy was associated with lower risks of 12-month all-cause (hazard ratio [95% CI], 0.79 [0.76–0.82]) and cardiovascular (hazard ratio [95% CI], 0.83 [0.78–0.88]) mortality, as well as with a lower rate of hospitalizations (incidence rate ratio [95% CI], 0.89 [0.87–0.92]) after initiating dialysis. These lower outcome risks persisted across strata of clinical characteristics, and in propensity score analyses. Conclusions: Among veterans with non–dialysis-dependent chronic kidney disease, treatment with statin therapy within the 1 year before transitioning to end-stage renal disease is associated with favorable early end-stage renal disease outcomes.

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