Association between statin therapy as primary prevention and mortality in adults 50 years and older with chronic kidney disease without other indications.

BACKGROUND Chronic kidney disease (CKD) increases cardiovascular and mortality risk. Guidelines recommend statins for primary prevention in individuals aged ≥50 years with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, but implementation and outcomes remain unclear. This study examined statin use and its association with all-cause mortality in individuals with CKD and no other indication for statin therapy.

METHODS A retrospective cohort study was conducted using healthcare data derived from Region Halland, Sweden. Adults aged 50-89 years with ≥2 eGFR measurements <60 mL/min/1.73 m2 during 2018-2021 were included, excluding those with prior cardiovascular disease, diabetes, primary hyperlipidemia, dialysis, or kidney transplantation. Follow-up from January 2021 to December 2023 included prevalence of statin use and all-cause mortality. Cox regression estimated adjusted hazard ratios (HR) for mortality, accounting for age, sex, CKD stage, albuminuria, hypertension, and use of statins, renin-angiotensin-aldosterone system (RAASi) inhibitors, and sodium-glucose-cotransporter-2 (SGLT2i) inhibitors.

RESULTS Among 7,177 individuals (50% women), 38% received statins. Statin use was associated with lower three-year mortality (14% vs. 19%, p < 0.001). Crude mortality rates were 42 vs. 57 deaths per 1,000 person-years. Statin use was associated with reduced mortality risk (HR 0.82, 95% CI:0.72-0.92). Higher age, advanced CKD stage, and hypertension were independently associated with increased mortality. RAASi use was protective (HR 0.31, 95% CI:0.27-0.35).

CONCLUSION Statin therapy was associated with lower all-cause mortality but was underutilized in adults ≥50 years with CKD. These findings have supported broader implementation of guideline-recommended statin therapy.