Efeito de baixas doses de sinvastatina sobre marcadores inflamatórios e nutricionais de pacientes em hemodiálise

Abstract

BACKGROUND: The traditional cardiovascular risk factors and the Chronic Kidney Disease (CKD) related risk factors contribute to the extremely high rate of cardiovascular mortality seems in dialysis population. The coexistence of malnutrition, inflammation, accelerated atherosclerosis, vascular calcification and anemia has an enormous impact in the life span of these patients. As in the general population, statins reduce cardiovascular mortality in dialysis population through lipid lowering and its pleiotropic effects, mainly by the chronic inflammatory process reduction capacity, shown up by the high-sensitive C-reactive protein levels (CRP-hs) reduction. The group of dialysis patients with low LDL-cholesterol (LDL-c), elevated CRP-hs levels and anemia present the highest cardiovascular risk and there are no definite evidences of benefit with statins use. OBJECTIVE: To evaluate the efficacy of a low dose of simvastatin that aims only pleiotropic effects in comparison with a standard dose in CRP-hs levels reduction, hematimetric parameters, erythropoietin resistance (EPO-RI), body mass index (BMI) and inflammation score (MIS). METHODS: Forty-two stable dialysis patients with more than six months on maintenance dialysis program, with more than 18 years old and without inflammation evidence were divided based on LDL-c basal levels. The patients with LDL-c <100mg/dl received only 20mg of simvastatin after hemodialysis session (HD) (group-1), while the patients with LDL-c >100mg/dl (group-2) received 20mg/day during eight weeks follow-up phase. Before and after the statin use, the CRP-hs levels and hematimetric parameters was measured and calculated the EPO-RI, BMI and MIS. The data were analyzed with the SPSS statistic program, through. Was considered significant p<0.05. RESULTS: We found a significant reduction of LDL-c and CRP-hs levels in both groups, but the LDL-c levels reduction was significantly bigger in group-2 (16,26±17,51% vs 37,73±11,73%, p<0,0001) while the PCR-hs levels reduction was equivalent in both groups (35,97±49,23% vs 38,32±32,69%, p=0,86). Lowering of EPO-RI and improvement of hematimetric parameters were also observed. There were no changes in BMI or MIS. CONCLUSION: The pleiotropic dose showed itself as efficient as the usual dose in CRP-hs levels, EPO-RI reduction and improvement of hematimetric parameters, showing an important cardiovascular risk reduction in these patients.