SynthesisLipids in health and disease2024

Efficacy and safety of statin therapy in kidney transplant recipients: a systematic review and meta-analysis.

Ioannis Bellos, Pagona Lagiou, Vassiliki Benetou, Smaragdi Marinaki

Abstract readSystematic ReviewMeta-Analysis
In one paragraph

Synthesis in Lipids in health and disease, 2024. The graph read 5 numbers from its abstract, feeding 3 cells of the map, but none could be read as for or against, so it casts no vote. It also reports 5 associations that do not count as treatment evidence, such as RR 1.22 (1.14 to 1.31) for cataract. Cited by 9 papers.

5numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
field-weighted citation impact
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

CataractStatin use vs no usean association or prognostic statement, not a treatment comparison · ascvd, dyslipidemiafeeds one cell of the map
RR 1.221.14 to 1.31
Regarding safety endpoints, statin use was associated with a lower risk of hepatotoxicity (RR: 0.81, 95% CI: 0.70-0.93, moderate certainty), but with a greater risk of rhabdomyolysis (RR: 1.37, 95% CI: 1.10-1.70, low certainty) and cataract (RR: 1.22, 95% CI: 1.14-1.31, moderate certainty).
Overall mortalityStatin use vs no usean association or prognostic statement, not a treatment comparison · ascvd, dyslipidemiafeeds one cell of the map
RR 0.840.74 to 0.94
Statin use compared to no use was associated with a lower risk of major adverse cardiovascular events [Relative risk (RR): 0.87, 95% confidence interval (CI): 0.67-0.96, moderate certainty] and overall mortality (RR: 0.84, 95% CI: 0.74-0.94, low certainty).
HepatotoxicityStatin use vs no usean association or prognostic statement, not a treatment comparison · ascvd, dyslipidemiafeeds one cell of the map
RR 0.810.70 to 0.93
Regarding safety endpoints, statin use was associated with a lower risk of hepatotoxicity (RR: 0.81, 95% CI: 0.70-0.93, moderate certainty), but with a greater risk of rhabdomyolysis (RR: 1.37, 95% CI: 1.10-1.70, low certainty) and cataract (RR: 1.22, 95% CI: 1.14-1.31, moderate certainty).
RhabdomyolysisStatin use vs no usean association or prognostic statement, not a treatment comparison · ascvd, dyslipidemiafeeds one cell of the map
RR 1.371.10 to 1.70
Regarding safety endpoints, statin use was associated with a lower risk of hepatotoxicity (RR: 0.81, 95% CI: 0.70-0.93, moderate certainty), but with a greater risk of rhabdomyolysis (RR: 1.37, 95% CI: 1.10-1.70, low certainty) and cataract (RR: 1.22, 95% CI: 1.14-1.31, moderate certainty).
Major adverse cardiovascular eventsStatin use vs no usean association or prognostic statement, not a treatment comparison · ascvd, dyslipidemiafeeds one cell of the map
RR 0.870.67 to 0.96
Statin use compared to no use was associated with a lower risk of major adverse cardiovascular events [Relative risk (RR): 0.87, 95% confidence interval (CI): 0.67-0.96, moderate certainty] and overall mortality (RR: 0.84, 95% CI: 0.74-0.94, low certainty).

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×adverse events & safety

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

11 readable studies in this cell: 3 favour the treatment, 7 find no difference, 1 favour the comparator.

Belief with this paper
0.16contested · 1 family supports, 4 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the comparatorfavours the treatment →
0 · no effect
NCT002899002,340 enrolled · 2006
Δ 13.79.40 to 18.0
NCT01294683977 enrolled · 2011
Δ -1.03-7.30 to 5.25
NCT00728988499 enrolled · 2008
Δ 1.00-7.30 to 9.30
NCT01678820299 enrolled · 2012
Δ -0.40-10.2 to 9.30

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.

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.

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

9 citing papers in PubMed.

  1. Article
  2. Review
  3. Review
  4. Review
  5. Review
  6. Review
  7. Review
  8. Kidney Transplant: More than Immunological Problems.Journal of clinical medicine · 2025
    Review
  9. Article
6 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

7 · Who and what money

Authors and funding

4 authors.

Ioannis BellosDepartment of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias str, Athens, 115 27, Greece. bellosg@windowslive.com.
Pagona LagiouDepartment of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias str, Athens, 115 27, Greece.
Vassiliki Benetou *Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias str, Athens, 115 27, Greece.
Smaragdi Marinaki *Department of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias str, Athens, 115 27, Greece.

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

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

backgroundDyslipidemia represents an important risk factor for cardiovascular diseases, although its optimal management after kidney transplantation remains unclear. The present meta-analysis aimed to shed light on the efficacy and safety of statins among kidney transplant recipients, evaluating their potential effects on the risk of cardiovascular events, mortality and graft survival.

methodsMedline, Scopus, Web of Science, CENTRAL, Clinicaltrials.gov and Google Scholar were systematically searched from their inception through April 20, 2024. Both randomized controlled trials and observational studies evaluating the effects of statin administration after kidney transplantation were held eligible. Random-effects models were fitted using the maximum likelihood method, while the certainty of evidence was appraised following the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach.

resultsOverall, 27 studies (10 randomized controlled trials and 17 observational studies) were included. Statin use compared to no use was associated with a lower risk of major adverse cardiovascular events [Relative risk (RR): 0.87, 95% confidence interval (CI): 0.67-0.96, moderate certainty] and overall mortality (RR: 0.84, 95% CI: 0.74-0.94, low certainty). The risk of graft loss did not differ between the compared groups (RR: 0.72, 95% CI: 0.48-1.08, very low certainty). Regarding safety endpoints, statin use was associated with a lower risk of hepatotoxicity (RR: 0.81, 95% CI: 0.70-0.93, moderate certainty), but with a greater risk of rhabdomyolysis (RR: 1.37, 95% CI: 1.10-1.70, low certainty) and cataract (RR: 1.22, 95% CI: 1.14-1.31, moderate certainty). No statistically significant differences between the compared groups with and without statin use were observed concerning the risk of creatine kinase elevation, post-transplant diabetes mellitus, hip fracture, venous thromboembolism, or cancer.

conclusionsAmong kidney transplant recipients, statin use is associated with a lower risk of cardiovascular events and better patient survival, presenting an acceptable safety profile. Further large-scale studies are needed to determine the optimal statin dosing strategy and lipid-lowering goals, depending on comorbidities and immunosuppression regimens. REGISTRATION: https://doi.org/10.17504/protocols.io.5qpvok3yzl4o/v1 .

Indexed as

Cardiovascular DiseasesHydroxymethylglutaryl-CoA Reductase InhibitorsKidney TransplantationDyslipidemiasGraft SurvivalHumansRandomized Controlled Trials as TopicTransplant RecipientsHydroxymethylglutaryl-CoA Reductase InhibitorsCardiovascularDyslipidemiaKidney transplantationStatinSystematic review

Identifiers

PMID39261803
PMCPMC11389595

What Socratic holds

Texttitle and abstract
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

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.