SynthesisAnnals of internal medicine2012

Benefits and harms of statin therapy for persons with chronic kidney disease: a systematic review and meta-analysis.

Suetonia C Palmer, Jonathan C Craig, Sankar D Navaneethan, Marcello Tonelli, Fabio Pellegrini, Giovanni F M Strippoli

Registry-linked trialAbstract readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in Annals of internal medicine, 2012. The graph read 6 numbers from its abstract, feeding 2 cells of the map, but none could be read as for or against, so it casts no vote. It is linked to trial NCT03779529 (EVOO-coratina Intervention on Lipids in Non-diabetic Hypertensive), which is not on this map. Cited by 150 papers, 15 of them syntheses that pooled it.

6numbers the graph read from it
0cells of the map it votes in
150citing papers in PubMed, 15 pooled it
48.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

Read, but not usablea number the graph found but could not read as for or against

Cardiovascular eventscomparator not stated · ascvd, ckdfeeds one cell of the map
RR 0.760.73 to 0.80
Moderate- to high-quality evidence indicated that statins reduced all-cause mortality (relative risk [RR], 0.81 [95% CI, 0.74 to 0.88]), cardiovascular mortality (RR, 0.78 [CI, 0.68 to 0.89]), and cardiovascular events (RR, 0.76 [CI, 0.73 to 0.80]) in persons not receiving dialysis.
Cardiovascular eventscomparator not stated · ascvd, ckdfeeds one cell of the map
RR 0.780.68 to 0.89
Moderate- to high-quality evidence indicated that statins reduced all-cause mortality (relative risk [RR], 0.81 [95% CI, 0.74 to 0.88]), cardiovascular mortality (RR, 0.78 [CI, 0.68 to 0.89]), and cardiovascular events (RR, 0.76 [CI, 0.73 to 0.80]) in persons not receiving dialysis.
Cardiovascular eventscomparator not stated · ascvd, ckdfeeds one cell of the map
RR 0.940.82 to 1.07
Moderate- to high-quality evidence indicated that statins had little or no effect on all-cause mortality (RR, 0.96 [CI, 0.88 to 1.04]), cardiovascular mortality (RR, 0.94 [CI, 0.82 to 1.07]), or cardiovascular events (RR, 0.95 [CI, 0.87 to 1.03]) in persons receiving dialysis.
All-cause mortalitycomparator not stated · ascvd, ckdfeeds one cell of the map
RR 0.810.74 to 0.88
Moderate- to high-quality evidence indicated that statins reduced all-cause mortality (relative risk [RR], 0.81 [95% CI, 0.74 to 0.88]), cardiovascular mortality (RR, 0.78 [CI, 0.68 to 0.89]), and cardiovascular events (RR, 0.76 [CI, 0.73 to 0.80]) in persons not receiving dialysis.
All-cause mortalitycomparator not stated · ascvd, ckdfeeds one cell of the map
RR 0.960.88 to 1.04
Moderate- to high-quality evidence indicated that statins had little or no effect on all-cause mortality (RR, 0.96 [CI, 0.88 to 1.04]), cardiovascular mortality (RR, 0.94 [CI, 0.82 to 1.07]), or cardiovascular events (RR, 0.95 [CI, 0.87 to 1.03]) in persons receiving dialysis.
Cardiovascular eventscomparator not stated · ascvd, ckdfeeds one cell of the map
RR 0.950.87 to 1.03
Moderate- to high-quality evidence indicated that statins had little or no effect on all-cause mortality (RR, 0.96 [CI, 0.88 to 1.04]), cardiovascular mortality (RR, 0.94 [CI, 0.82 to 1.07]), or cardiovascular events (RR, 0.95 [CI, 0.87 to 1.03]) in persons receiving dialysis.

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Statins×cardiovascular events

No readable resultOpen on the map →What to test next →

30 readable studies in this cell: 18 favour the treatment, 11 find no difference, 1 favour the comparator.

Belief with this paper
0.86replicated · 12 families support, 2 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
HR 0.710.56 to 0.90
NCT023442907,769 enrolled · 2015
HR 0.640.48 to 0.84
HR 1.781.00 to 3.17
NCT03944512102 enrolled · 2019
RR 0.670.37 to 1.19

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

Statins×all-cause mortality

No readable resultOpen on the map →What to test next →

14 readable studies in this cell: 3 favour the treatment, 9 find no difference, 2 favour the comparator.

Belief with this paper
0.50contested · 3 families support, 2 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT023442907,769 enrolled · 2015
HR 0.880.70 to 1.12
HR 1.010.91 to 1.11
NCT03944512102 enrolled · 2019
RR 0.670.37 to 1.19
RR 0.990.89 to 1.11

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03779529 naunknown statusnot on this mapstarted 2018, after this paper: background citation

EVOO-coratina Intervention on Lipids in Non-diabetic Hypertensive (h) Patients With Hyperlipidemia (h) Undergoing Periodic Hemodialysis (h)

TypeinterventionalSponsorFondazione SchenaRan2018 to 2021Enrolled24ConditionsChronic Kidney Disease Stage VArmsOlive oil
5 · Its place in the literature

Who cites it

150 citing papers in PubMed, 15 syntheses or guidelines pooled it, 350 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. Pooled it
  4. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2022
    Guideline
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Statins and Cardiovascular Primary Prevention in CKD: A Meta-Analysis.Clinical journal of the American Society of Nephrology : CJASN · 2015 · on this map
    Pooled it
  11. Guideline
  12. Pooled it
  13. Potential increased risk of cancer from commonly used medications: an umbrella review of meta-analyses.Annals of oncology : official journal of the European Society for Medical Oncology · 2014
    Pooled it
  14. HMG CoA reductase inhibitors (statins) for dialysis patients.The Cochrane database of systematic reviews · 2013 · on this map
    Pooled it
  15. Pooled it
  16. Trial
  17. Trial
  18. Trial
  19. Trial
  20. Trial

90 more citing papers are in PubMed but not listed here.

6 · The record

Corrections and comments

7 · Who and what money

Authors and funding

6 authors at 4 institutions in 4 countries.

Suetonia C PalmerUniversity of Otago, Christchurch, 2 Riccarton Avenue, PO Box 4345, Christchurch 8041, New Zealand.
Jonathan C Craig
Sankar D Navaneethan
Marcello Tonelli
Fabio Pellegrini
Giovanni F M Strippoli
Mario Negri Institute for Pharmacological Research · ITCleveland Clinic · USUniversity of Alberta · CAUniversity of Sydney · AU

Funding

NCRR NIH HHS KL2 RR024990
8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundStatins have uncertain benefits in persons with chronic kidney disease (CKD) because individual trials may have insufficient power to determine whether treatment effects differ with severity of CKD. PURPOSE: To summarize the benefits and harms of statin therapy for adults with CKD and examine whether effects of statins vary by stage of kidney disease. DATA SOURCES: Cochrane and EMBASE databases (inception to February 2012). STUDY SELECTION: Randomized trials comparing the effects of statins with placebo, no treatment, or another statin on mortality and cardiovascular outcomes. DATA EXTRACTION: Two independent reviewers extracted data and assessed risk of bias. DATA SYNTHESIS: Eighty trials comprising 51099 participants compared statin with placebo or no treatment. Treatment effects varied with stage of CKD. Moderate- to high-quality evidence indicated that statins reduced all-cause mortality (relative risk [RR], 0.81 [95% CI, 0.74 to 0.88]), cardiovascular mortality (RR, 0.78 [CI, 0.68 to 0.89]), and cardiovascular events (RR, 0.76 [CI, 0.73 to 0.80]) in persons not receiving dialysis. Moderate- to high-quality evidence indicated that statins had little or no effect on all-cause mortality (RR, 0.96 [CI, 0.88 to 1.04]), cardiovascular mortality (RR, 0.94 [CI, 0.82 to 1.07]), or cardiovascular events (RR, 0.95 [CI, 0.87 to 1.03]) in persons receiving dialysis. Effects of statins in kidney transplant recipients were uncertain. Statins had little or no effect on cancer, myalgia, liver function, or withdrawal from treatment, although adverse events were evaluated systematically in fewer than half of the trials. LIMITATION: There was a reliance on post hoc subgroup data for earlier stages of CKD.

conclusionStatins decrease mortality and cardiovascular events in persons with early stages of CKD, have little or no effect in persons receiving dialysis, and have uncertain effects in kidney transplant recipients.

Indexed as

BiasCardiovascular DiseasesCause of DeathHumansHydroxymethylglutaryl-CoA Reductase InhibitorsKidney TransplantationLipidsRenal DialysisRenal Insufficiency, ChronicSensitivity and SpecificityHydroxymethylglutaryl-CoA Reductase InhibitorsLipids

Identifiers

PMID22910937
PMCPMC3955032
OpenAlexW1967917591

What Socratic holds

Texttitle and abstract
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.