Effect of Statin Therapy on the Progression of Autosomal Dominant Polycystic Kidney Disease. A Secondary Analysis of the HALT PKD Trials.

Abstract

BACKGROUND:

Autosomal dominant polycystic kidney disease (ADPKD) commonly results in end-stage renal disease (ESRD), yet a long-term treatment that is well tolerated is still lacking. In a small randomized trial in children and adolescents pravastatin administration for 3 years was associated with reduced renal cyst growth, but no large trial has tested the effect of statins in adults.

METHODS:

We performed a post-hoc analysis of the HALT PKD trials to compare outcomes of participants who never used statins with those who used statin for at least 3 years. Because statins were not randomly allocated, we used propensity score models with inverse probability of treatment weighting to account for imbalances between the groups. For subjects in Study A (preserved renal function, n=438) relevant outcomes were percent change in total kidney and liver volume and the rate of decline in estimated glomerular filtration rate (eGFR); for those in Study B (reduced renal function, n=352) we compared time to the composite endpoint of death, ESRD or 50% decline in eGFR. Follow-up was 5-8 years.

RESULTS:

There was no difference in any outcome between the 2 groups. However, limitations of this analysis are the small number of statin users in Study A, different statin drugs and doses used, non-randomized allocation and advanced disease stage in Study B.

CONCLUSION:

Although this post-hoc analysis of the HALT PKD trials does not demonstrate a benefit of statin therapy, conclusions remain preliminary. A larger randomized trial in young people with ADPKD is necessary to answer the question whether statins can slow renal cyst growth and preserve kidney function.

• Authors: Godela M Brosnahan, Kaleab Z Abebe, Frederic F Rahbari-Oskoui, Charity G Patterson, Kyongtae T Bae, Robert W Schrier, William E Braun, Arlene B Chapman, Michael F Flessner, Peter C Harris, Ronald D Perrone, Theodore I Steinman, Vicente E Torres, HALT PKD Investigators
• Journal: Current hypertension reviews (Curr Hypertens Rev) Vol. 13 Issue 2 Pg. 109-120 ( 2017) ISSN: 1875-6506 [Electronic] United Arab Emirates
• PMID: 28460625 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright© Bentham Science Publishers; For any queries, please email at [email protected].

Chemical References

• Antihypertensive Agents
• Hydroxymethylglutaryl-CoA Reductase Inhibitors

Topics

• Adolescent
• Adult
• Antihypertensive Agents (therapeutic use)
• Disease Progression
• Female
• Glomerular Filtration Rate (drug effects)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (adverse effects, therapeutic use)
• Kidney (drug effects, pathology, physiopathology)
• Kidney Failure, Chronic (diagnosis, etiology, mortality, prevention & control)
• Male
• Middle Aged
• Multicenter Studies as Topic
• Polycystic Kidney, Autosomal Dominant (complications, diagnosis, drug therapy, mortality)
• Randomized Controlled Trials as Topic
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome
• Young Adult