HMG-coenzyme A reductase inhibitor use is associated with mortality reduction in hemodialysis patients

Background: Cardiovascular disease is the most common cause of mortality in patients with end-stage renal disease. Cardiovascular benefits of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) have been clearly established in the general population, but not in dialysis patients. This study examined statin prescription patterns and assessed the relationship between statin prescription and clinical outcomes in hemodialysis (HD) patients. Methods: Data were analyzed from the Dialysis Outcomes and Practice Patterns Study, a prospective observational study of HD patients randomly selected from representative dialysis facilities in France, Germany, Italy, Spain, the United Kingdom, Japan, and the United States. Predictors of statin prescription were investigated by means of logistic regression. Cox regression models tested the association between statin prescription and risk for mortality and cardiac events, with adjustments for common demographic factors and comorbid conditions. Results: Statins were prescribed for 11.8 % of HD patients overall. Most facilities (81.2 %) prescribed statins to less than 20 % of their patients. Patients prescribed statins had a 31 % lower relative risk for death compared with those not prescribed statins (P < 0.0001). Statins were associated with a 23 % lower cardiac mortality risk (P = 0.03) and a 44 % lower noncardiac mortality risk (P < 0.0001). At a facility level. prescribing statins was associated with lower overall mortality rate, with a 5 % lower risk for every 10 % increase in number of patients prescribed statins within the facility (P = 0.02). Conclusion: Stalin prescription is associated with reduced mortality in HD patients, providing additional support for the value of statin therapy in this patient group. (C) 2004 by the National Kidney Foundation, Inc.