• Rajesh Gupta, Laura C Plantinga, Nancy E Fink, Michal L Melamed, Josef Coresh, Caroline S Fox, Nathan W Levin, and Neil R Powe.
• Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md, USA.
• JAMA. 2007 Apr 4;297(13):1455-64.

ContextPatients with chronic kidney disease are at high risk for sepsis and sepsis-related mortality.ObjectiveTo assess whether statin use is associated with a reduction in sepsis events [corrected] in dialysis patients.Design, Setting, And PatientsNational prospective cohort study that enrolled 1041 incident dialysis patients at 81 US not-for-profit outpatient dialysis clinics from October 1995 to June 1998, with follow-up to January 2005. Statin use was determined by medical record review. Rates of sepsis events [corrected] between statin users and control patients were compared using multivariate regression models, with adjustment for potential confounders in the overall cohort and in a subcohort in which control patients were matched to statin users according to their likelihood (propensity) to have been prescribed a statin.Main Outcome MeasureSepsis events [corrected] were determined through hospital records from the United States Renal Data System (mean follow-up, 3.4 years).ResultsThere were 303 sepsis events [corrected] Rates of sepsis events [corrected] were significantly lower in patients receiving statins (crude incidence rate, 41/1000 patient-years) than in those not receiving statins (crude incidence rate, 110/1000 patient-years) (P<.001). With adjustment for demographics and dialysis modality, statin users were substantially less likely to be subsequently hospitalized for sepsis (incidence rate ratio, 0.41; 95% confidence interval [CI], 0.25-0.68). Further adjustment for comorbidities and laboratory values continued to show this protective association (incidence rate ratio, 0.38; 95% CI, 0.21-0.67). In the propensity-matched subcohort, statin use was even more protective (incidence rate ratio, 0.24; 95% CI, 0.11-0.49).ConclusionsUse of statins was strongly and independently associated with a reduction in the risk of sepsis events [corrected] in patients who had chronic kidney disease and were receiving dialysis. Randomized trials of statins in patients with chronic kidney disease should examine the prevention of sepsis as a potentially important benefit.

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