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REVIEW

Meta-Analysis: The Effect of Statins on Albuminuria

Kevin Douglas, MD; Patrick G. O'Malley, MD, MPH; and Jeffrey L. Jackson, MD, MPH

18 July 2006 | Volume 145 Issue 2 | Pages 117-124

Background: Albuminuria is an independent risk factor for cardiovascular and renal disease with limited therapeutic options. Data on the effects of statins on albuminuria are conflicting.

Purpose: To determine whether and to what degree statins affect albuminuria.

Data Sources: English-language and non–English-language studies found in PubMed, MEDLINE, EMBASE, BIOSIS, SciSearch, PASCAL, and International Pharmaceutical Abstracts (IPA) databases and the Cochrane Central Register of Controlled Trials that were published between January 1974 and November 2005.

Study Selection: Randomized, placebo-controlled trials of statins reporting baseline and follow-up measurements of albuminuria or proteinuria measured by 24-hour urine collection or the urinary albumin-to-creatinine ratio.

Data Extraction: Two investigators independently abstracted study quality, characteristics, and outcomes.

Data Synthesis: Fifteen studies involving a total of 1384 patients and averaging 24 weeks in duration were included. Meta-analysis of the proportional reduction in proteinuria showed that statins reduced albuminuria (11 studies) and proteinuria (4 studies) in 13 of 15 studies. The reduction in excretion was greater among studies with greater baseline albuminuria or proteinuria: change of 2% (95% CI, –32% to 35%) for those with excretion less than 30 mg/d, –48% (CI, –71% to –25%) for those with excretion of 30 to 300 mg/d, and –47% (CI, –67% to –26%) for those with excretion more than 300 mg/d. Statistical heterogeneity was evident only in the group with excretion greater than 300 mg/d (excretion < 30 mg/d, I² = 23% [P = 0.27]; excretion of 30 to 299 mg/d, I² = 0% [P = 0.64]; excretion 300 mg/d, I² = 63% [P = 0.020]).

Limitations: Published studies were not of high quality on average and varied markedly in effect size, as well as in characteristics of the cohorts. Unpublished studies showing no effect could impact these results.

Conclusion: Statins may have a beneficial effect on pathologic albuminuria. The validity of this finding, and whether this effect translates into reduction of cardiovascular or end-stage renal disease, requires larger studies.

Editors' Notes Context Albuminuria is a marker of endothelial dysfunction and is a risk factor for cardiovascular disease. We do not know whether or to what degree statins affect albuminuria. Contribution This meta-analysis of 15 randomized, placebo-controlled trials found that statins reduced albuminuria and proteinuria. Studies with greater baseline albuminuria showed greater reductions. Cautions Studies were small, showed heterogeneous effects, and were often of poor quality. Implications Statins might reduce albuminuria. We need larger, better studies to confirm these findings and to determine whether reducing albuminuria affects the incidence of end-stage renal disease or cardiovascular disease. —The Editors

 

Author and Article Information

From Walter Reed Army Medical Center, Washington, DC, and Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Disclaimer: The views expressed herein are those of the authors and do not necessarily reflect those of the U.S. Army or the U.S. Department of Defense.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Kevin Douglas, MD, Walter Reed Army Medical Center, 6900 Georgia Avenue, NW, Washington, DC 20307.

Current Author Addresses: Drs. Douglas, O'Malley, and Jackson: Walter Reed Army Medical Center, 6900 Georgia Avenue, NW, Washington, DC 20307.

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