THE COMPARATIVE EFFICACY AND SAFETY OF ATORVASTATIN VERSUS PRAVASTATIN IN DYSLIPIDEMIC PATIENTS ON PERITONEAL DIALYSIS

Objective: The aim of our study was to compare the efficacy and safety of atorvastatin versus pravastatin, in dyslipidémie patients on continuous ambulatory peritoneal dialysis (CAPD).Material and methods: Fifty-five hyperlipidémie CAPD patients were randomized to either atorvastatin (n=27) or pravastatin (n=28) treatment and prospectively followed for nine months. Hyperlipidemia was defined as TC >200mg/dl (5.2 mmol/L) and LDL-C >135 mg/dl (3.5 mmol/L). Both drugs were initiated at a dose of 10 mg/day and the doses were increased if LDL-C was >135 mg/dl at visits done every three months. The blood glucose, serum albumin total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), very low-density lipoprotein cholesterol (VLDL-C), triglyceride (TG), AST, ALT, GGT, uric acid, CPK, HbA1C were measured in the fasting blood samples taken at baseline, and at 3rd, 6th and 9th months of the treatment.Results: Both agents resulted in a marked reduction in the TC, LDL-C and TG levels; but no change was observed for VLDL-C and HDL- C in either of the treatment arms. The proportional decrease of TC and LDL-C was more marked in the atorvastatin group,compared to pravastatin group. No major side effects were observed with either of the statins in these patient groups.Conclusion: The results of our studydemonstrated that although both statins improved the lipid profiles and both are safe for use in dyslipidémie CAPD patients, and higher starting doses (20 mg) may be required for pravastatin in patients on CAPD treatment.Key Words: Dyslipidemia, Atorvastatin, Pravastatin, Continuous ambulatory peritoneal dialysis (CAPD)

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  • /. Foley RH, Parfrey PS, Sarnak MJ. Cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998:32:112-119.
  • Keane WF, Brenner BN, Nazzu A, Agro A. The Chorus (Cerivastatin in Heart Outcomes in
  • Renal Disease: Understading Survival)
  • protocol: A double blind, placebo-controlled trial in patients with ESRD. Am J Kidney Dis 2001;37:48-53.
  • Bertram L. Kasiske. Hyperlipidemia in patients with chronic renal disease. Am. J. Kidney Dis 1998;32:142-156.
  • Keane WF, Nulcahy IVS, Kasiske BL, Kim Y, O Donnell NP. Hyperlipidemia and progressive renal disease. Kidney Int 1991;31:41-48.
  • Rader DJ, Rosas S. Hypertriglycemia, low HDL Cholestrol, lipoprotein (a), in tyroid and renal diseases. Post-Transplantation 2000:84:52- 54.
  • Attman P, Alaupovic P, Samuelsson O. Lipoprotein abnormalities as a risk factor for progressive nondiabetic renal disease. Kidney Int 1999:56:14-18.
  • Shoji T, Hishizawa Y, Hishitani H, Yamakawa N, Morii H. Roles of hypoalbuminemia and lipoprotein lipase on hyperlipoproteinemia in continuous ambulatory peritoneal dialysis. Netabolism 1991;40:1002-1008.
  • Grodstein GP, Blumenkrantz NJ, Kopple JD, Moran JK, Coburn JW. Glucose absorption during continuous ambulatory peritoneal dialysis. Kidney Int 1981 ; 19:564-567.
  • Little J, Phillips L, Russell L, Griffiths A, Russell G I, Davies SJ. Longitudinal lipid profiles on CAPD: their relationship to weight gain, comorbidity, and dialysis factors. J Am Soc Hephrol 1998;9:1931-1939.
  • Bcrtolini S, Bon GB, Campbell LM, et al. Efficacy and safety of atorvastatin compared to pravastatin in patients with hypercholesterolemia. Atherosclerosis 1997; 130:191-197.
  • Tiawrocki JW, Weiss SR, Davidson NH, et al. Reduction of LDL cholesterol by 25 to 60% in patients with primary hypercholesterolemia by atorvastatin, a new HMG-CoA reductase inhibitor. Arterioscler Thromb Vase Biol 1995; 15:678-682.
  • Yukawa S, Mune M, Yamada Y, Otani H, Kishino N, Tone Y. Ongoing clinical trials of lipid reduction therapy in patients with renal disease. Kidney Int 1999; Supp Ho. 71.
  • Stephen L, Seliger S, Weiss SR, Gillen D. HNG- CoA reductase inhibitors are associated with reduced modality in ESRD patients. Kidney Int 2002;61:297-304.
  • Knopp RH. Drug treatment of lipid disorders. H Engl J Ned 1999;341 -.498-51 I.
  • Taylor AJ, Kent SN, Flaherty PJ, Coyle LC, Narkwood TT, Vernalis NH. ARBITER: Arterial
  • 5
  • Betül Ogütmen, et al.
  • Biology for the Investigation of the Treatment Effects of Reducing Cholesterol: a randomized trial comparing the effects of atorvastatin and pravastatin on carotid intima medial thickness. Circulation 2002; 106:2055-2060.
  • Beane WF, Mulcahy US, Kasiske BL, Him Y, O'Donnell MP. Hyperlipidemia and progressive renal disease. Kidney Int 1991 ;31:41 -48.
  • Masterson TIT. Safety and efficacy of
  • simvastatin in patients undergoing chronic renal dialysis: are we ready to treat
  • hypercholesterolemia? Am J Kidney Dis 2002; 39(2):419-421.
  • Bakker-Arkema R, Davidson IT, Goldstein R, et at. Efficacy and safety of a new HMG-CoA reductase inhibitor Atorvastatin in patients with hypertriglyceridemia. JANA 1996;275: 128-133.
  • Jones P, Kafonek S, Laurora I, Hunninghake
  • D. Comparative dose efficacy study of atorvastatin versus simvastatin, pravastatin, lovastatin, and fluvastatin in patients with hypercholesterolemia (the CURVES study). Am J Cardiol 1998;81:582- 587.
  • Harris KP, Wheeler DC, Chong CC. Atorvastatin in CAPD Study Investigators. Continuous ambulatory peritoneal dialysis. A placebo-controlled trial examining atorvastatin in dyslipidemic patients undergoing CAPD. Kidney Int 2002;61 (4): 1469-1474
  • «
  • Hufnagel G, Nichel C, Vrtovsnik F, Queffeulou G, Kossari IT, Nignon F. Effects of atorvastatin on dyslipidaemia in uraemic patients on peritoneal dialysis. Hephrol Dial Transplant 2000;15:684-688.
  • Saltissi D, Morgan C, Rigby RJ, Westhuyzen J. Safety and efficacy of simvastatin in
  • hypercholesterolemic patients undergoing chronic renal dialysis. Am J Kidney Dis 2002; 39:283-290.
  • Balaskas EV, Bamihas Gl, Tourkantonis A. Management of lipid abnormalities in patients on CAPD. Périt Dial Int 1997;17:308-309.
  • Singhal MK, Bhaskaran S, Szabo T, La Rosa R. ITo difference in plasma fibrinogen levels between CAPD patients taking atorvastatin and simvastatin. Périt Dial Int 1999; 19:89-91.
  • Lee MS, Kim SM, Kim SB, Lee SK, Park JS, Yang WS. Effects of gemfibrozil on lipid and hemostatic factors in CAPD patients. Périt Dial Int 1999,19:280-283.
  • Feriani M, Ronco C, La Greca G. Solutions for peritoneal dialysis. In: Jacobs C, Kjellstrand CM, Koch KM, Winchester JF, eds. Replacement of renal function by dialysis 4th Edition. Dordrecht: Kluwer Academic Publication, 1996:520-546
  • Gentile S, Turco S, Guarino Ci, et at. Comparative efficacy study of atorvastatin vs simvastatin, pravastatin, lovastatin and placebo in type 2 diabetic patients with hypercholesterolaemia. Diabetes Obes Metab 2000;2:355-362.
  • Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994,344:1383-1389.
  • Ooi TC, Meinonen T, Alaupovic P, et al. Efficacy and safety of a new hydroxymethylglutaryl-coenzyme a reductase inhibitor atorvastatin in patients with combined hyperlipidemia comparison with fenofibrate. Arterioscler Thromb Vase Biol 1997;17:1793-1799.