Statine verlagen sterfte na hart- of vaatziekte bij dialysepatiënten — REIN-registry

INTRODUCTION: While statins are effective for cardiovascular prevention in the general population, their benefit in patients with CKD G5D (kidney failure treated by dialysis) remains uncertain. Previous randomized controlled trials included mixed populations for primary and secondary prevention while excluding patients with recent cardiovascular events, leaving a knowledge gap regarding statin effectiveness for secondary prevention immediately following an atherosclerotic cardiovascular disease (ASCVD) event. Here, we address this gap by providing real-world evidence. METHODS: We conducted a landmark-based observational study, informed by the target trial framework using the French Renal Epidemiology and Information Network (REIN) registry and merged with data from the French national healthcare system database from 2010 to 2023. We included adults with CKD G5D who experienced an ASCVD event. We used inverse probability of treatment weighting to balance baseline characteristics between statin initiators and non-initiators, thereby estimating the average causal effect on all-cause mortality. Results focus on the relative and absolute risk difference and the life expectancy gain using delta restricted mean survival time (dRMST). RESULTS: The study cohort included 5534 patients (median age: 75 years; 67% male). During the ten years of follow-up, statin use was associated with a reduced risk of mortality. The survival curves reached a maximum absolute difference at year four (risk difference -6.2% (95% CI: -10.2; -2.2); relative risk 0.88 [95% CI: 0.81; 0.96]). Life expectancy extended significantly over time with a mean survival gain of 69 days at five years (95% CI: 14-125) and reaching 135 days at ten years (95% CI: 31-239). No difference was identified between groups regarding hospitalizations for rhabdomyolysis or toxic hepatitis. CONCLUSIONS: In patients receiving dialysis, statin initiation following an ASCVD event is safe and associated with a modest-to-moderate ten-year cumulative survival benefit. While interpreted within observational limitations, this real-world evidence supports their use in this secondary prevention setting.