Supplementary Material for: Meta-Analysis of Lipid-Lowering Therapy in Maintenance Dialysis Patients

Background/Aims: The use of lipid-lowering therapy
(LLT) in patients on chronic dialysis is contentious. Here we present an
aggregate data meta-analysis of randomised controlled trials (RCTs)
comparing long-term LLT versus placebo in dialysis patients. Method:
A search of Medline, Google Scholar, COCHRANE database, EMBASE, and
cardiovascular and nephrology society proceedings was performed.
Criteria for inclusion were RCTs of LLT versus placebo, in which LLT was
demonstrated to significantly reduce low-density lipoprotein
cholesterol, >12 months of follow-up, and at least one cardiovascular
or mortality endpoint in an independently reported dialysis population.
Meta-analysis was performed for atherosclerotic cardiovascular events,
stroke and mortality using a random-effects method for odds ratio (OR)
of risk. Results: Three studies were included with 7,051
patients (3,541 treatment and 3,510 placebo). Twenty-five percent of the
LLT patients suffered an atherosclerotic cardiovascular event versus
27% for placebo. The OR was 0.89 (95% CI: 0.80-0.99, p = 0.04). For
stroke (haemorrhagic and non-haemorrhagic combined), the figures were
6.2% (LLT) versus 5.7% (placebo) [OR = 1.11 (95% CI: 0.85-1.46, p =
0.45)]. For all-cause mortality, the figures were 40 versus 42% [OR =
0.97 (95% CI: 0.88-1.06, p = 0.49)]. Conclusion: There was
an overall significant reduction in risk for atherosclerotic
cardiovascular events in dialysis patients treated with LLT compared to
placebo. There was a numerical but not a statistical reduction in
mortality. There was no statistically significant increase in risk of
stroke as has been previously reported.

背景/目标：在慢性透析患者中应用降脂治疗（LLT）存在争议。本研究旨在通过综合分析随机对照试验（RCTs），比较长期LLT与安慰剂在透析患者中的疗效。方法：对Medline、Google Scholar、Cochrane数据库、EMBASE以及心血管和肾病学会会议论文进行了检索。纳入标准包括LLT与安慰剂的RCTs，其中LLT被证明可以显著降低低密度脂蛋白胆固醇，随访时间超过12个月，并在独立报道的透析人群中至少包含一个心血管或死亡率终点。采用随机效应方法对风险比（OR）进行元分析，分析了动脉粥样硬化性心血管事件、中风和死亡率。结果：纳入了3项研究，涉及7,051名患者（3,541名接受治疗，3,510名接受安慰剂）。LLT组的25%患者发生了动脉粥样硬化性心血管事件，而安慰剂组为27%（OR = 0.89，95% CI: 0.80-0.99，p = 0.04）。对于中风（包括出血性和非出血性），LLT组为6.2%，安慰剂组为5.7%（OR = 1.11，95% CI: 0.85-1.46，p = 0.45）。对于全因死亡率，LLT组为40%，安慰剂组为42%（OR = 0.97，95% CI: 0.88-1.06，p = 0.49）。结论：与安慰剂相比，接受LLT治疗的透析患者在动脉粥样硬化性心血管事件风险方面具有显著的降低。死亡率方面虽有降低趋势，但未达到统计学意义。未观察到先前报道的中风风险增加的统计学意义。