D J TUNNICLIFFE1,2, S PALMER3, J C CRAIG1,2,4, D W JOHNSON5, B CASHMORE1,2, V M SAGLIMBENE1,2, R KRISHNASAMY6, K LAMBERT7, G FM STRIPPOLI1,2,8
1School of Public of Health, The University Of Sydney, Sydney, Australia, 2Centre for Kidney Research, The Children’s at Westmead , Sydney, Australia, 3Department of Medicine, University of Otago, Christchurch, New Zealand, 4Department of Medicine and Health, Flinders University, Adelaide, Australia, 5University of Queensland at the Princess Alexandra Hospital, Brisbane, Australia, 6Department of Nephrology, Sunshine Coast Hospital University Hospital, Sunshine Coast, Australia, 7Discipline of Nutrition and Dietetics, Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, Australia, 8Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
Aim: To evaluate the benefits and harms of statins compared to placebo/standard of care in people with chronic kidney disease (CKD) not requiring dialysis, using processes to update the related systematic review in near real-time.
Background: Statins improve survival and reduce cardiovascular events in CKD. Previous guidelines on statins use in CKD have not been updated since 2013 and new evidence is available. Guidelines based on up-to-date evidence are needed to improve patient outcomes.
Methods: This project is a partnership between CARI Guidelines and Cochrane Kidney and Transplant. We updated a random-effects meta-analysis of randomized controlled trials on statin therapy in people with CKD. Certainty of the evidence was assessed using GRADE. The evidence was surveyed monthly, using the Cochrane Kidney and Transplant Registry. Semi-automated tools and digital platforms were used to collaborate and automate evidence synthesis.
Results: The Cochrane review was updated in 20 days by 1 FTE. Sixty-two trials (58,814 participants) including 12 new trials were included. Compared with placebo/standard of care, statins reduced cardiovascular events (RR 0.72, 95%CI 0.66-0.79) and death (RR 0.80, 95%CI 0.70-0.90) (high certainty of the evidence). Statins probably reduced myocardial infarction (RR 0.55, 95%CI 0.42-0.73) and revascularisation procedures (RR 0.62, 95%CI 0.47-0.82) (moderate certainty of the evidence). Statins probably had no effect on stroke (RR 0.64, 95%CI 0.37-1.08) or kidney failure (RR 0.98, 95%CI 0.91-1.05) (moderate certainty of the evidence). There was insufficient evidence for rhabdomyolysis (very low certainty of the evidence).
Conclusions: Statins lowered death and major cardiovascular events in people with CKD. This rapidly updated review will form the evidence synthesis for the CARI Living Guideline on statins in CKD currently being developed.
Dr David Tunnicliffe was awarded a PhD (medicine) at the Sydney School of Public Health, The University of Sydney in 2018. He is a Research Fellow at the School of Public Health, The University of Sydney based at the Centre for Kidney Research, The Children’s Hospital at Westmead. He has been awarded an NHMRC Emerging Leadership 1 Investigator Grant to examine the application and evaluation of living evidence in kidney disease.