Lupus: What Is It, Symptoms, Treatment, Rash, and More
Could Statins Reduce Death Risk In Chronic Kidney Disease?
A statin was the most prescribed drug in the United States in 2020, and guidance is continually being updated recommending the expansion of the use of this type of drug.
Initially prescribed in the late 1980s to people who had had a heart attack to prevent them from having another one, statins provided a way to lower levels of low-density lipoprotein (LDL) cholesterol, also known as "bad" cholesterol. This prevents the hardening and narrowing of the arteries which can lead to high blood pressure.
Previously, the only interventions that had been available to people at greater risk of heart disease had been lifestyle interventions, such as diet and exercise. However, research has since shown that statins are more effective than many lifestyle interventions at lowering LDL cholesterol.
The maximum safe dose of some statins can reduce LDL cholesterol levels by up to 55% on their own, and potentially further in conjunction with other drugs.
Understanding the role of cholesterol to health is so critical that the Nobel Prize in Physiology or Medicine 1985 was awarded jointly to Michael Brown and Joseph Goldstein "for their discoveries concerning the regulation of cholesterol metabolism."
A study published in The Lancet in 2002 showed that people who were at high risk of cardiovascular disease had their risk of heart attack and stroke reduced by 25% over 5 years when they took 40 milligrams (mg) of simvastatin daily.
Since the introduction of statins in the late 1980s, their use has been expanded to include more people deemed to be at risk of cardiovascular disease or major cardiovascular events in the next 10 years.
Recently, the REPRIEVE trial reported its results on the impact of statins in people with HIV. Results published in the The Lancet show that the statin pitavastatin lowers the risk of cardiovascular events by 35% in people with HIV.
Campaigners are now calling for guidelines to be updated to outline that all people with HIV over the age of 40 should be offered statins.
Now, a study published in JAMA Network Open, has shown that older people, mainly men, with chronic kidney disease could benefit from taking statins.
Data on U.S. Veterans over the age of 65 was collected from Veterans Affairs, Medicaid and Medicare, focusing on those with moderate chronic kidney disease, stages 3 or 4. The cohort was 99% male and had a mean age of 76.9 when they received a diagnosis of chronic kidney disease.
Researchers analyzed data from 17,609 veterans, and they identified 14,685 individuals with chronic kidney disease but who were not taking statins, and 2,924 with kidney disease who were offered statins. All these participants were followed up for 3.6 years.
Results showed that taking statins reduced overall mortality in veterans with chronic kidney disease by 9%.
While there was also a reduction in the number of major adverse cardiovascular events seen among the group who took statins, this difference was not significant.
The study authors did not speculate over the mechanism underpinning these findings in their paper, but they called for a randomized control trial to investigate the discovery further. This would allow for the collection of data on any side effects and harms caused by the medication to be collected, as these were not in this analysis.
Dr. Barry Sears, a researcher in inflammation and founder of the Inflammation Research Foundation, not involved in the current study, offered a hypothesis to Medical News Today:
"Statins can activate AMPK [the 5′-adenosine monophosphate-activated protein kinase pathway], which is a major controller of inflammation at the molecular level by inhibiting NK-κB activity. This would reduce mortality in any chronic disease associated with inflammation such as chronic kidney disease."
"The effect on cardiovascular mortality is less than on [chronic kidney disease] mortality," he added. "However, statins do have side effects, such as muscle damage and diabetes which may explain the differences between mortality data from [chronic kidney disease] and cardiovascular events. Thus, the efficacy of statins in treating other chronic diseases associated with inflammation is a very open question."
The lead author of the current study, Dr. Ariela Orkaby, suggested to MNT that inflammation could be one of the mechanism underpinning the findings.
She said: "Statins lower inflammation. People with chronic kidney disease have higher rates of inflammation than the general population but also importantly, people with chronic kidney disease have a high risk of cardiovascular events. "
"So these are people who at baseline have a higher risk of cardiovascular disease. Part of our hypothesis was — if we we look and see whether they started statins or not, that [those who were taking statins] would also benefit just like other people who don't have cardiovascular disease yet," she added.
Dr. Orkaby also said she and her colleagues had chosen to study this group of participants because there was a lack of information available on the impact of statins in older people.
A study published in 2022 by the U.S. Preventative Services Task Force showed that there was not sufficient evidence to determine the harms and benefits of statin use in people over 76.
Dr. Orkaby said:
"You know, the big class of people that we don't have enough evidence in, is the growing aging population. So that's people over 75. And there's an ongoing trial right now called PREVENTABLE that is testing this. And that is really key because the largest group of people who are at the highest risk of cardiovascular events [are] older adults, and yet in the past they were routinely excluded from clinical trials."
They were not the only group who had been underrepresented, and many could benefit from an analysis of how beneficial statins are in those groups, she added.
Dr. Orkaby emphasized: "Women historically have been underrepresented. If we look across autoimmune disorders, people with rheumatoid arthritis and similar conditions. These are people who have not been included in trials and yet there's emerging evidence that statins may play a role for lowering the risk of future heart attacks."
The researchers hope that future clinical trials will include more representative cohorts.
Stages Of Chronic Kidney Disease
Chronic kidney disease has five stages. These start from a mildly damaged kidney and may end with kidney failure. Early diagnosis and treatment can help stop the disease from progressing.
Chronic kidney disease (CKD) is a condition that affects the ability of your kidneys to function properly.
Kidneys are responsible for filtering your blood by removing waste, toxins, and surplus fluids. However, damaged kidneys don't filter blood as well as they should. This can lead to serious health concerns.
There are five stages of CKD, and different symptoms and treatments are associated with each stage.
To assign a CKD stage, two tests are required to assess how well your kidneys work, according to the National Kidney Foundation (NKF).
The first is a urine test to assess your albumin-creatinine ratio (ACR). This shows if protein is leaking into the urine, which may be a sign of kidney damage. A higher level indicates more kidney damage.
ACR levels are staged as follows:
The second is a blood test called the estimated glomerular filtration rate (eGFR). This shows how well your kidneys are filtering your blood. A GFR of 100 mL/min is normal. GFR shows how much blood your kidneys filter in 1 minute.
To classify your kidney damage into a stage, these tests need to be repeated to monitor long-term kidney damage, which is damage of at least 3 months.
The table below highlights the five stages of CKD. More information about each stage follows the table.
In stage 1, there's very mild damage to the kidneys. They're quite adaptable and can adjust for this, allowing them to keep performing at 90% or better.
At this stage, CKD is likely to be discovered by chance during routine blood and urine tests. You may also have these tests if you have diabetes or high blood pressure. These are the top causes of CKD in the United States, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD).
SymptomsTypically, there are no symptoms when kidneys function at 90% or better.
TreatmentThe NIDDKD suggests taking the following steps to help slow disease progression:
A doctor may refer you to a kidney specialist, called a nephrologist. They can provide more tailored advice for you.
In stage 2 CKD, kidneys are functioning between 60–89%.
SymptomsAt this stage, you might still be symptom-free. Or symptoms are nonspecific, such as:
There's no cure for CKD, but following the NIDDKD's recommendations and early treatment can slow or stop progression.
It's essential to address the underlying cause and to manage any conditions, such as diabetes, high blood pressure, or heart disease.
Stage 3A CKD is when your kidney is functioning between 45–59%. Stage 3B means kidney function is between 30–44%.
The kidneys aren't filtering waste, toxins, and fluids well, which are starting to build up.
According to the NKF, this is the first stage when people are typically diagnosed with CKD because it's when an eGFR blood test alone can detect it.
SymptomsNot everyone has symptoms at stage 3. However, you may experience:
Complications may include:
A healthcare professional may recommend you make dietary changes, such as reducing your intake of sodium, calcium, potassium, and phosphorate.
It's important to manage underlying conditions to help preserve kidney function. This may include taking:
A healthcare professional may also recommend you stop taking some medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs).
You may also require frequent follow-up visits and tests so adjustments can be made if necessary.
Stage 4 CKD means you have moderate-to-severe kidney damage. They're functioning between 15–29%, so you may build up more waste, toxins, and fluids in your body.
At this stage, it's important to do everything you can to prevent progression to kidney failure.
According to the Centers for Disease Control and Prevention (CDC), 40% of people with severely reduced kidney function aren't even aware they have it.
SymptomsSymptoms can include:
Complications can include:
You're also at increased risk of heart disease and stroke.
TreatmentIn stage 4, it's important to work closely with healthcare professionals. You should also start discussing treatments like dialysis and kidney transplants in case your kidneys fail.
In addition, stage 4 CKD can lead to further health complications requiring treatment. For example, it's not uncommon to develop metabolic acidosis due to CKD. Depending on blood bicarbonate levels, doctors may prescribe oral bicarbonate replacement therapy.
Stage 5 CKD means your kidneys are working at less than 15% capacity, or you have kidney failure.
When this happens, the buildup of waste and toxins becomes life threatening. This is end-stage renal disease.
SymptomsSymptoms of kidney failure can include:
A significant drop in kidney function puts more stress on the heart, increasing the risk of heart disease and stroke.
TreatmentOnce you have complete kidney failure, life expectancy is only a few months without dialysis or a kidney transplant.
Dialysis isn't a cure for CKD, but a process to help remove waste and fluid from your blood. There are two types of dialysis, hemodialysis and peritoneal dialysis.
HemodialysisYou will receive hemodialysis either at a dialysis center or at home. Hemodialysis at a medical center typically occurs on a set schedule around three times a week.
However, with training, you can administer hemodialysis at home, although it requires a surgical procedure to create vein access. You and a doctor can tailor home dialysis schedules to fit your lifestyle better. Home hemodialysis is typically more frequent but lasts for less time per session.
During the treatment, you or a doctor will insert two needles into an access point on your body. These attach to a dialyzer, which is a machine sometimes referred to as an artificial kidney. Your blood then pumps through the filter and returns to your body.
Peritoneal dialysisFor peritoneal dialysis, a surgeon will place a catheter into your abdomen.
During treatment, dialysis solution flows through the catheter into the abdomen, after which you can go about your normal day. A few hours later, you can drain the catheter into a bag and discard it. It's necessary to repeat this multiple times per day.
A kidney transplant involves replacing your kidney with a healthy one. Kidneys can come from living or deceased donors. You won't need dialysis, but you'll have to take anti-rejection medication for the rest of your life.
What is life expectancy by CKD stage?In people with CKD, life expectancy can be difficult to estimate. While disease progression typically reduces a person's life expectancy, other factors such as age at diagnosis, other health conditions, and treatment options can all significantly impact life expectancy.
What stage of CKD do you need dialysis?You will typically require dialysis at stage 5 or end-stage kidney failure.
Will drinking more water increase my GFR?Staying hydrated is crucial for overall kidney health and maintaining GFR. However, drinking more water will not significantly improve GFR results in the short term.
There are five stages of CKD. Stages are determined with blood and urine tests and the degree of kidney damage.
While CKD is a progressive disease, not everyone will go on to develop kidney failure.
Symptoms of early-stage kidney disease are mild and can be easily overlooked. That's why it's important to have regular checkups if you have diabetes or high blood pressure, the leading causes of kidney disease.
Early diagnosis and management of coexisting conditions can help slow or prevent progression.
Cricketer Cameron Green Reveals He's Fighting Chronic Kidney Disease: Here's Everything You Should Know About
Cameron Donald Green, 24-year-old Australian Cricketer recently talked about a disease that he has been struggling with his entire life. The disease is irreversible and at one time, put his life expectancy at 12 years. We are talking about Chronic Kidney Disease. Cameron has featured in 24 Tests, 23 ODIs, and eight T20Is since making his Australia debut in 2020. In a recent interview, the cricketer opened up about how he was born with the disease and has been dealing with it since. So, what is Chronic Kidney Disease?
The function of kidneys in the body is to filter wastes and fluid from the body. However, when the kidney function starts to decline progressively, it is called Chronic Kidney Disease or Chronic Kidney Failure. When kidney function declines and the toxins aren't filtered from the body the way they should be, it can lead to conditions like high blood pressure, anemia, and electrolyte imbalances.
According to Dr. Mohit Khirbat, Consultant, Nephrology, CK Birla Hospital, Gurugram, kidney function level is measured in glomerular filtration rate or GFR which is then used to determine the stage of the disease. Based on that, it ranges from very mild kidney damage to end-stage renal disease, which requires dialysis or a kidney transplant to survive.
The symptoms of chronic kidney disease are very non-specific and develop over time as the damage keeps developing. The symptoms can include:
Chronic Kidney Disease usually occurs when the kidney function gets affected by a disease or condition. Such conditions or diseases can be:
The treatment for Chronic Kidney Disease completely depends on the causes and stage of the condition.
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