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Association of Statin Use With Mortality After Dialysis-Requiring Acute Kidney Injury: A Population-Based Cohort Study

  • Chia-Lin Wu
    Affiliations
    Division of Nephrology, Changhua Christian Hospital, Changhua, Taiwan

    Environmental and Precision Medicine Laboratory, Changhua Christian Hospital, Changhua, Taiwan

    School of Medicine, Chung-Shan Medical University, Taichung, Taiwan

    Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Chew-Teng Kor
    Affiliations
    Environmental and Precision Medicine Laboratory, Changhua Christian Hospital, Changhua, Taiwan

    Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua, Taiwan
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  • Chia-Chu Chang
    Affiliations
    Division of Nephrology, Changhua Christian Hospital, Changhua, Taiwan

    Environmental and Precision Medicine Laboratory, Changhua Christian Hospital, Changhua, Taiwan

    School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
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  • Ping-Fang Chiu
    Affiliations
    Division of Nephrology, Changhua Christian Hospital, Changhua, Taiwan

    School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
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  • Der-Cherng Tarng
    Correspondence
    Der-Cherng Tarng, MD, PhD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei, Taiwan 11217.
    Affiliations
    Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

    Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan

    Division of Nephrology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Chih-Cheng Hsu
    Correspondence
    Correspondence: Address to Chih-Cheng Hsu, MD, DrPH, Institute of Population Health Sciences, National Health Research Institutes, No. 35, Keyan Road, Zhunan, Miaoli County, Taiwan 35053.
    Affiliations
    Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

    Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan

    Department of Health Services Administration, China Medical University, Taichung, Taiwan

    Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
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      Abstract

      Objective

      To investigate the association between statin use and mortality in patients with dialysis-requiring acute kidney injury (AKI-D).

      Patients and Methods

      This nationwide, population-based, retrospective cohort study included 6091 hospitalized patients with AKI-D (1271 statin users and 4820 statin nonusers) retrieved from the National Health Insurance Research Database of Taiwan between January 1, 2000, and December 31, 2012. All the patients were followed up until December 31, 2013. Primary and secondary outcomes were 1-year and in-hospital mortality, respectively. All the primary analyses were performed using the intention-to-treat approach.

      Results

      During 1-year follow-up, 492 of 1271 statin users (38.7%) and 2365 of 4820 statin nonusers (49.1%) died. After propensity score matching, statin use was independently associated with lower risks of 1-year all-cause mortality (hazard ratio [HR], 0.79; 95% CI, 0.69-0.9; P<.001) and in-hospital all-cause mortality (HR, 0.84; 95% CI, 0.71-0.99; P=.04). The survival benefit of statin treatment was dose-dependent and consistent across subgroups based on sensitivity analyses.

      Conclusion

      Statin use was independently associated with reduced risks of 1-year and in-hospital mortality in patients with AKI-D. Statin therapy may be beneficial in this patient group. However, further clinical trials should be performed to confirm the findings.

      Abbreviations and Acronyms:

      ACEI (angiotensin-converting enzyme inhibitor), AKI (acute kidney injury), AKI-D (dialysis-requiring acute kidney injury), ARB (angiotensin II receptor blocker), AT (as-treated), CAD (coronary artery disease), CCIS (Charlson Comorbidity Index score), cDDD (cumulative defined daily dose), CHF (congestive heart failure), CKD (chronic kidney disease), COPD (chronic obstructive pulmonary disease), CRRT (continuous renal replacement therapy), CVD (cardiovascular disease), DDD (defined daily dose), HR (hazard ratio), ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), ICU (intensive care unit), ITT (intention-to-treat), NHIRD (National Health Insurance Research Database), NSAID (nonsteroidal anti-inflammatory drug), NTD (new Taiwan dollars), PAOD (peripheral artery occlusive disease)
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