Impact of Statin Therapy on Long-Term Survival of Patients with Chronic Kidney Disease but Without Atherosclerotic Cardiovascular Disease: Insights from the American MIMIC-IV and Chinese CIN-II Databases

Abstract

Objective

Patients with chronic kidney disease (CKD) without atherosclerotic cardiovascular disease (ASCVD) have high mortality rates. Guidelines indicate that statin therapy can reduce mortality in CKD patients with ASCVD; however, its benefits for CKD patients without ASCVD remain unclear. This study examined the survival benefits of statin therapy in CKD patients without ASCVD in American and Chinese cohorts.

Methods

A total of 4369 patients diagnosed with CKD without concurrent ASCVD were included from the American Medical Information Mart for Intensive Care (MIMIC)-IV database (n = 1786) and the Chinese Multicenter Registry Cohort for Cardiorenal Improvement II (CIN-II, n = 2583). Participants were grouped by statin use (treated and untreated). The two groups were compared for key indicators, including: (1) statin use rate; (2) 4-year all-cause mortality; (3) 4-year cardiovascular mortality (assessed in the CIN-II cohort). Statistical analyses included Kaplan–Meier survival curves (with log-rank test for group differences) and Cox proportional hazard models (adjusted for confounders) to estimate the association between statin use and mortality.

Results

In the MIMIC-IV cohort, 37.6% of CKD patients received statins, with a 4-year all-cause mortality of 36.3%. After adjustment, statin therapy was associated with lower all-cause mortality (adjusted hazard ratio [aHR]: 0.61; 95% confidence interval [CI]: 0.51–0.72; P < 0.001). In the CIN-II cohort, 33.9% of patients received statins; the 4-year all-cause and cardiovascular mortalities were 10.5% and 5.3%, respectively. Adjusted analyses demonstrated that statin therapy reduced both all-cause mortality (aHR: 0.74; 95% CI: 0.56–0.99; P = 0.037) and cardiovascular mortality (aHR: 0.64; 95% CI: 0.42–0.97; P = 0.031).

Conclusion

Approximately two-thirds of CKD patients without ASCVD in both the American (MIMIC-IV) and Chinese (CIN-II) cohorts did not receive statins. However, statin therapy reduced 4-year all-cause mortality by 26% and 39% in the American and Chinese cohorts, respectively. These findings highlight a clear survival benefit of statin therapy and warrant future randomized controlled trials.

Keywords

Chronic kidney disease / Statin therapy / Mortality / Real-world cohorts

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Funding

National Natural Science Foundation of China(82270339)

AstraZeneca Externally Sponsored Research Project(ESR-23-22118)

Guangdong Provincial Science and Technology Project(KJ022021049)

Basic and Applied Basic Research Foundation of Guangdong Province(2022A1515012126)

RIGHTS & PERMISSIONS

The Author(s), under exclusive licence to the Huazhong University of Science and Technology