We have carefully read the article by Cheng et al.,1 recently published in JASN, hereafter referred to as the original article. However, we have noticed several minor issues that we would like to discuss with the authors.
First, the inclusion and exclusion criteria for dialysis and nondialysis patients were not clearly described, leading to inconsistencies in the discussion. On page 885, the article claims to innovatively include both dialysis and nondialysis kidney failure patients in a unified analysis, addressing a gap in the field. Yet, on the next page, it states that the study's limitation is the lack of distinction between dialysis and nondialysis patients. The overall positive results of the study conflict with the negative outcomes of the Study of Heart and Renal Protection (SHARP) trial's dialysis subgroup, but the reasons for this discrepancy were not thoroughly discussed. Although the sample size is insufficient to support subgroup analysis, the overall conclusions implicitly apply to all kidney failure patients, including those on dialysis. Palmer et al.2 found that the effects of statin therapy vary by CKD stage: statins can reduce all-cause mortality, cardiovascular mortality, and cardiovascular disease in nondialysis patients but have minimal effect on dialysis patients, with uncertain efficacy in kidney transplant recipients. Nemerovski's research3 indicates that statin therapy does not significantly alter the progression of cardiovascular disease events in patients with kidney failure, and current evidence does not support the routine use of statins in this population.
The original article claims that statins do not increase the risk of myopathy or liver dysfunction, but dialysis patients may have higher risks due to kidney function loss and drug accumulation. The lack of subgroup safety analysis might obscure risks in specific populations, and dose-dependent side effects (such as rhabdomyolysis with high-dose statins) and drug interactions were not assessed. Notably, the literature4 reports an association between statin use in kidney failure and higher risk of upper urinary tract urothelial cancer, suggesting caution regarding potential noncardiovascular risks of long-term use.
Overall, statins seem to be well tolerated in patients with kidney failure. However, conflicting results from different studies indicate that the efficacy of statins may depend on the stage of kidney disease and the type of KRT. Future research should be designed to stratify patients by dialysis status to clarify the differences in efficacy and safety of statin therapy among various kidney failure populations.
Footnotes
See related reply, “Authors’ Reply: Statins' Efficacy Controversy in Kidney Failure: Reassessing Safety and Dialysis Stratification Need,” on pages 1881–1882, and original article, “Long-Term Benefits and Safety of Statins in Patients with Kidney Failure: A Target Trial Emulation Study,” in Vol. 36, Iss. 5, pages 882–889.
Disclosures
Disclosure forms, as provided by each author, are available with the online version of the article at http://links.lww.com/JSN/F293.
Author Contributions
Conceptualization: Jiaru Lin, Lin Luo.
Methodology: Jiaru Lin, Lin Luo.
Writing – original draft: Jiaru Lin.
Writing – review & editing: Lin Luo.
Funding
L. Luo: Luzhou Science and Technology Bureau (2022-SYF-76).
References
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