Effect of statin therapy on the progression of autosomal dominant polycystic kidney disease. A secondary analysis of the HALT PKD trials

the HALT PKD Investigators

Research output: Contribution to journalArticle

12 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)109-120
Number of pages12
JournalCurrent Hypertension Reviews
Volume13
Issue number2
DOIs
StatePublished - Jan 1 2017

Fingerprint

Autosomal Dominant Polycystic Kidney
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Kidney
Therapeutics
Glomerular Filtration Rate
Chronic Kidney Failure
Cysts
Pravastatin
Propensity Score
Growth
Liver

Keywords

  • Autosomal dominant polycystic kidney disease
  • End-stage renal disease
  • Glomerular filtration rate
  • HALT PKD trials
  • Hydroxymethylglutaryl-CoA reductase inhibitors
  • Total kidney volume

ASJC Scopus subject areas

  • Internal Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Effect of statin therapy on the progression of autosomal dominant polycystic kidney disease. A secondary analysis of the HALT PKD trials. / the HALT PKD Investigators.

In: Current Hypertension Reviews, Vol. 13, No. 2, 01.01.2017, p. 109-120.

Research output: Contribution to journalArticle

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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.",
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AU - Abebe, Kaleab Z.

AU - Rahbari-Oskoui, Frederic F.

AU - Patterson, Charity G.

AU - Bae, Kyongtae T.

AU - Schrier, Robert W.

AU - Braun, William E.

AU - Chapman, Arlene B.

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AU - Steinman, Theodore I.

AU - Torres, Vicente

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