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Should statins be prescribed for primary prevention of cardiovascular disease in patients with chronic kidney disease?

BMJ 2009; 339 doi: (Published 20 August 2009) Cite this as: BMJ 2009;339:b2949
  1. Andrew Connor, specialist registrar in renal and general medicine 1,
  2. Charlie Tomson, consultant nephrologist2
  1. 1Department of Renal Medicine, Dorset County Hospital, Dorchester DT1 2JY
  2. 2Richard Bright Renal Unit, Southmead Hospital, Bristol BS10 5NB
  1. Correspondence to: A Connor, 3 Hope Terrace, Martinstown DT2 9JN andrewconnor1974{at}
  • Accepted 26 May 2009

Most patients with early chronic kidney disease are managed in primary care. These patients have an increased risk of cardiovascular disease; the lower the estimated glomerular filtration rate, the higher the risk.1 Patients with stages 1 to 4 of chronic kidney disease are more likely to die from cardiovascular disease than to require renal replacement therapy, and cardiovascular disease is the most common cause of death among dialysis and transplant patients.2

However, the causal pathway is unclear; conventional cardiovascular risk factors (including dyslipidaemia) may also cause kidney disease progression, but kidney disease may also cause cardiovascular disease through pathways unrelated to dyslipidaemia. The benefits of lipid lowering treatment in primary and secondary prevention of cardiovascular disease in people with preserved renal function are well established.3 4 Recent guidance from the National Institute for Health and Clinical Excellence (NICE) recommends treatment with statins for secondary prevention of cardiovascular disease in all patients with chronic kidney disease, irrespective of the lipid profile, although patients with chronic kidney disease remain less likely to be prescribed statins after a cardiovascular event, despite the side effects being similar to those of placebo.5 6 7 However, the role of statins in primary prevention among patients with chronic kidney disease remains uncertain.

What is the evidence of the uncertainty?

We searched PubMed for randomised controlled trials comparing statins with placebo or no treatment in adult patients with chronic kidney disease, using the following search terms: “statin”, “chronic kidney disease”, and “renal failure”.

Primary prevention

Whether the association …

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