Statins associated with fewer hospitalizations for sepsis in patients with CKD undergoing dialysis

Key Points

Statins can reduce the risk of hospitalization for sepsis in patients with chronic kidney disease (CKD) who are receiving dialysis, according to the results of a large cohort study published in the Journal of the American Medical Association (JAMA).

Although the efficacy of statins to lower cholesterol levels and prevent cardiac events in the general population is well known, the current finding is new. Statins are thought to have what are referred to as "pleiotropic effects," or beneficial effects outside of their ability to lower cholesterol. In particular, statins have been demonstrated to exert immunomodulatory properties that may allow the drugs to regulate the immune response to infection, thus reducing the risk of sepsis in patients with infections.

The Choices for Healthy Outcomes in Caring for End Stage Renal Disease (CHOICE) study included 1,041 patients undergoing dialysis at 81 outpatient dialysis clinics throughout the United States. Patients were enrolled from October 1995 to June 1998 and were followed-up to January 2005 (mean, 3.4 y) to determine the risk of hospitalization for sepsis using data from the United States Renal Data System (USRDS).

The authors stated: "To our knowledge, this is the first study to show a strong and significant effect of a medication administered long-term on lower rates of sepsis among patients with chronic kidney disease."

Infection is the second-leading cause of mortality among the >300,000 patients in the United States undergoing dialysis. Sepsis is a contributing factor in >75% of these infection-related deaths.

"In light of the high rates of sepsis and sepsis-related mortality in [patients with CKD], these findings are important and warrant the examination of the prevention of sepsis as a potentially important benefit in a randomized trial," the authors stated.

SOURCES

Gupta R, Plantinga LC, Fink NE, et al. Statin use and hospitalization for sepsis in patients with chronic kidney disease. JAMA. 2007;297:1455–1464.

Sarnak MJ, Jaber BL. Mortality caused by sepsis in patients with end-stage renal disease compared with the general population. Kidney Int. 2000;58:1758–1764.