• Cardiovascular disease (CVD) and peripheral artery disease (PAD) disproportionately affect people receiving dialysis, with a prevalence of more than 65% and 40%, respectively.
• Lo et al. compared the outcomes of 3235 patients receiving and not receiving statin therapy. After 3 years of follow-up, the statin group had an incidence of 18.9% for CV death and 9.7% for the composite outcome of EVT and amputation. In contrast, the nonstatin group had an incidence of 21.2% for CV death and 11.2% for the composite outcome of EVT and amputation. In further analyses, they report that persons receiving high-potency statins received the most significant benefit compared with those receiving low- to moderate-potency statins and those not receiving statins.
• However, evidence from clinical practice and clinical trial data are inconsistent.
• Based on these findings, the 2013 Kidney Disease: Improving Global Outcomes guidelines suggested that statin therapy should not be initiated in patients receiving dialysis (based on grade A high-quality evidence); however, it could be continued in patients already receiving this therapy at the time of dialysis initiation (based on grade C low-quality evidence).
• More recent studies reported that continuation of statin therapy after the transition to dialysis and, in some cases, initiation of statin therapy after dialysis might remain beneficial.
• Most patients commencing dialysis have several CVD risk factors, including PAD; hence, early initiation of high-potency statin medication may provide the highest risk reduction for CVD, including reduced risk of significant adverse limb events.

Reference: Garimella PS, Duval S. Statin Therapy in Persons Receiving Dialysis—Does Peripheral Artery Disease Change the Equation? JAMA Netw Open. 2022;5(9):e2229713.