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Curr Hypertens Rev. 2017;13(2):109-120. doi: 10.2174/1573402113666170427142815.

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

Author information

1
University of Colorado, Denver, Colorado CO. United States.
2
University of Pittsburgh, Pittsburgh, Pennsylvania PA. United States.
3
Emory University, Atlanta. Georgia.
4
Carolinas HealthCare System, Charlotte, North Carolina NC. United States.
5
Cleveland Clinic, Cleveland, Ohio OH. United States.
6
University of Chicago, Chicago, Illinois IL. United States.
7
National Institutes of Health, Bethesda, Maryland MD. United States.
8
Mayo Clinic, Rochester, Minnesota MN. United States.
9
Tufts Medical Center, Boston, Massachusetts MA. United States.
10
Beth Israel Deaconess Medical Center, Boston, Massachusetts MA. United States.

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.

KEYWORDS:

Autosomal dominant polycystic kidney disease; HALT PKD trials; end-stage renal disease; glomerular filtration rate; hydroxymethylglutaryl-CoA reductase inhibitors; total kidney volume

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