• Shiyu Zhou, Licong Su, Ruqi Xu, Yanqin Li, Ruixuan Chen, Yue Cao, Peiyan Gao, Xiaodong Zhang, Fan Luo, Qi Gao, Shengli An, Wenyi Cai, Lilong Lin, Hong Xu, Bicheng Liu, Jianping Weng, Chen Chunbo, Huafeng Liu, Qiongqiong Yang, Hua Li, Yaozhong Kong, Guisen Li, Qijun Wan, Yan Zha, Ying Hu, Gang Xu, Yongjun Shi, Yilun Zhou, Guobin Su, Ying Tang, Mengchun Gong, Xin Xu, and Sheng Nie.
• Division of Nephrology (S. Zhou, L. Su, R. Xu, Y. Li, Chen, Cao, P. Gao, Zhang, Luo, Q. Gao, X. Xu, Nie), National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Biostatistics (An), School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China; Huiqiao Medical Center (Cai), Standardized General Practice Training Site, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Cardiology (Lin), State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China; Children's Hospital of Fudan University (H. Xu), Shanghai, China; Institute of Nephrology (B. Liu), Zhongda Hospital, Southeast University School of Medicine, Nanjing, China; Department of Endocrinology (Weng), The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; Department of Critical Care Medicine (Chunbo), Maoming People's Hospital, Maoming, China; Key Laboratory of Prevention and Management of Chronic Kidney Disease of Zhanjiang City (H. Liu), Institute of Nephrology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China; Department of Nephrology (Yang), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Sir Run Run Shaw Hospital (H. Li), Zhejiang University School of Medicine, Hangzhou, China; Department of Nephrology (Kong), the First People's Hospital of Foshan, Foshan, Guangdong, China; Renal Department and Institute of Nephrology (G. Li), Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Center for Kidney Diseases, Chengdu, China; The Second People's Hospital of Shenzhen (Wan), Shenzhen University, Shenzhen, China; Guizhou Provincial People's Hospital (Zha), Guizhou University, Guiyang, China; The Second Affiliated Hospital of Zhejiang University School of Medicine (Ying Hu), Hangzhou, China; Division of Nephrology (G. Xu), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Huizhou Municipal Central Hospital (Shi), Sun Yat-Sen University, Huizhou, China; Department of Nephrology (Y. Zhou), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Nephrology (G. Su), Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China; The Third Affiliated Hospital of Southern Medical University (Tang), Guangzhou, China; Institute of Health Management (Gong), Southern Medical University, Guangzhou, China; DHC Technologies (Gong), Beijing, China.
• CMAJ. 2023 May 29; 195 (21): E729E738E729-E738.

BackgroundThe role of statin therapy in the development of kidney disease in patients with type 2 diabetes mellitus (DM) remains uncertain. We aimed to determine the relationships between statin initiation and kidney outcomes in patients with type 2 DM.MethodsThrough a new-user design, we conducted a multicentre retrospective cohort study using the China Renal Data System database (which includes inpatient and outpatient data from 19 urban academic centres across China). We included patients with type 2 DM who were aged 40 years or older and admitted to hospital between Jan. 1, 2000, and May 26, 2021, and excluded those with pre-existing chronic kidney disease and those who were already on statins or without follow-up at an affiliated outpatient clinic within 90 days after discharge. The primary exposure was initiation of a statin. The primary outcome was the development of diabetic kidney disease (DKD), defined as a composite of the occurrence of kidney dysfunction (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2 and > 25% decline from baseline) and proteinuria (a urinary albumin-to-creatinine ratio ≥ 30 mg/g and > 50% increase from baseline), sustained for at least 90 days; secondary outcomes included development of kidney function decline (a sustained > 40% decline in eGFR). We used Cox proportional hazards regression to evaluate the relationships between statin initiation and kidney outcomes, as well as to conduct subgroup analyses according to patient characteristics, presence or absence of dyslipidemia, and pattern of dyslipidemia. For statin initiators, we explored the association between different levels of lipid control and outcomes. We conducted analyses using propensity overlap weighting to balance the participant characteristics.ResultsAmong 7272 statin initiators and 12 586 noninitiators in the weighted cohort, statin initiation was associated with lower risks of incident DKD (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.62-0.83) and kidney function decline (HR 0.60, 95% CI 0.44-0.81). We obtained similar results to the primary analyses for participants with differing patterns of dyslipidemia, those prescribed different statins, and after stratification according to participant characteristics. Among statin initiators, those with intensive control of high-density lipoprotein cholesterol (LDL-C) (< 1.8 mmol/L) had a lower risk of incident DKD (HR 0.51, 95% CI 0.32-0.81) than those with inadequate lipid control (LDL-C ≥ 3.4 mmol/L).InterpretationFor patients with type 2 DM admitted to and followed up in academic centres, statin initiation was associated with a lower risk of kidney disease development, particularly in those with intensive control of LDL-C. These findings suggest that statin initiation may be an effective and reasonable approach for preventing kidney disease in patients with type 2 DM.© 2023 CMA Impact Inc. or its licensors.

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