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Sökning: onr:"swepub:oai:DiVA.org:uu-244519" > The effect of lower...

LIBRIS Formathandbok  (Information om MARC21)
FältnamnIndikatorerMetadata
00003883naa a2200433 4500
001oai:DiVA.org:uu-244519
003SwePub
008150217s2014 | |||||||||||000 ||eng|
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-2445192 URI
0247 a https://doi.org/10.2215/CJN.103710132 DOI
040 a (SwePub)uu
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Herrington, William4 aut
2451 0a The effect of lowering LDL cholesterol on vascular access patency :b post hoc analysis of the Study of Heart and Renal Protection
264 1c 2014
338 a print2 rdacarrier
520 a BACKGROUND AND OBJECTIVES:Reducing LDL cholesterol (LDL-C) with statin-based therapy reduces the risk of major atherosclerotic events among patients with CKD, including dialysis patients, but the effect of lowering LDL-C on vascular access patency is unclear.DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:The Study of Heart and Renal Protection (SHARP) randomized patients with CKD to 20 mg simvastatin plus 10 mg ezetimibe daily versus matching placebo. This study aimed to explore the effects of treatment on vascular access occlusive events, defined as any access revision procedure, access thrombosis, removal of an old dialysis access, or formation of new permanent dialysis access.RESULTS:Among 2353 SHARP participants who had functioning vascular access at randomization, allocation to simvastatin plus ezetimibe resulted in a 13% proportional reduction in vascular access occlusive events (355 [29.7%] for simvastatin/ezetimibe versus 388 [33.5%] for placebo; risk ratio [RR], 0.87; 95% confidence interval [95% CI], 0.75 to 1.00; P=0.05). There was no evidence that the effects of treatment differed for any of the separate components of this outcome. To test the hypothesis raised by SHARP, comparable analyses were performed using the AURORA (A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events) trial cohort. AURORA did not provide independent confirmation (vascular access occlusive events: 352 [28.9%] for rosuvastatin versus 337 [27.6%] for placebo; RR, 1.06, 95% CI, 0.91 to 1.23; P=0.44). After combining the two trials, the overall effect of reducing LDL-C with a statin-based regimen on vascular access occlusive events was not statistically significant (707 [29.3%] with any LDL-C-lowering therapy versus 725 [30.5%] with placebo; RR, 0.95, 95% CI, 0.85 to 1.05; P=0.29).CONCLUSIONS:Exploratory analyses from SHARP suggest that lowering LDL-C with statin-based therapy may improve vascular access patency, but there was no evidence of benefit in AURORA. Taken together, the available evidence suggests that any benefits of lowering LDL-C on vascular access patency are likely to be modest.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicin0 (SwePub)3022 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicine0 (SwePub)3022 hsv//eng
7001 a Emberson, Jonathan4 aut
7001 a Staplin, Natalie4 aut
7001 a Blackwell, Lisa4 aut
7001 a Fellström, Bengtu Uppsala universitet,Njurmedicin4 aut0 (Swepub:uu)bengfell
7001 a Walker, Robert4 aut
7001 a Levin, Adeera4 aut
7001 a Hooi, Lai Seong4 aut
7001 a Massy, Ziad A4 aut
7001 a Tesar, Vladimir4 aut
7001 a Reith, Christina4 aut
7001 a Haynes, Richard4 aut
7001 a Baigent, Colin4 aut
7001 a Landray, Martin J4 aut
7102 a Uppsala universitetb Njurmedicin4 org
7730 t Clinical journal of the American Society of Nephrology : CJASNg 9:5, s. 914-919q 9:5<914-919x 1555-905X
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-244519
8564 8u https://doi.org/10.2215/CJN.10371013

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