Background Recommendations have not yet been established for
statin therapy in patients on maintenance dialysis. In this study, we aimed to evaluate the effects of
statin therapy on all-cause mortality in patients undergoing maintenance
hemodialysis. Methods and Results This retrospective cohort study analyzed data from adults, aged ≥30 years, who were on maintenance
hemodialysis for
end-stage renal disease. Data on
statin use, along with other clinical information between 2007 and 2017, were extracted from the Health Insurance Review and Assessment Service database in Korea. In total, 65 404 patients were included, and 41 549 (73.2%) patients had received
statin therapy for a mean duration of 3.6±2.6 years. Compared with
statin nonusers before and after the initiation of
hemodialysis (entry), patients who initiated
statin therapy after entry and patients who continued
statins from the pre-
end-stage renal disease to post-
end-stage renal disease period had a lower risk of all-cause mortality; the adjusted hazard ratios (95% CIs) were 0.48 (0.47-0.50; P<0.001) for post-
end-stage renal disease only
statin users and 0.59 (0.57-0.60; P<0.001) for continuous
statin users. However, those discontinuing
statins before or at entry showed a higher risk of all-cause mortality.
Statin-
ezetimibe combinations were associated with better survival benefits than fixed patterns of
statin therapy. These results were consistent across various subgroups, including elderly patients aged >75 years, and were maintained even after propensity score matching. Conclusions Our results showed that in adult patients undergoing maintenance
hemodialysis,
statin therapy, preferably combined with
ezetimibe, was associated with a lower risk of all-cause mortality.