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

<p><b><i>Background/Aims:</i></b> 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. <b><i>Method:</i></b>
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. <b><i>Results:</i></b> 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)]. <b><i>Conclusion:</i></b> 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.</p>