Association of Serum Phosphate with Efficacy of Statin Thera
Statins are less efficacious in reducing cardiovascular disease risk in patients on dialysis than in the general population. In this post hoc analysis, the efficacy of statin treatment according to serum phosphate levels in the patients on dialysis who were participants of the A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events (AURORA) trial using serum phosphate levels at baseline and during the trial course. They first classified the patients by groups of similar phosphate trajectories over time and tested whether phosphate as a longitudinal exposure (summarized by the identified trajectory groups) modulated the occurrence of major adverse cardiovascular events and all-cause death.

In the AURORA trial, using multivariable analysis, they found that the treatment effect of statin on major adverse cardiovascular events and all-cause death was significant and protective effects in patients with low values of serum phosphate gradually faded for higher phosphate levels >5 mg/dl. A similar lack of statin treatment efficacy for both outcomes was observed with high baseline phosphate levels (>5 mg/dl). In the 4D trial, they found a comparable but not significant trend toward losing treatment efficacy in the presence of high serum phosphate levels for both outcomes.

Study results demonstrated the limited treatment efficacy of statins in patients on dialysis in the presence of hyperphosphatemia.