Statins started after a cardiovascular event on dialysis were associated with longer survival

Design

Registry-based target-trial emulation with inverse probability weighting

Population

5,534 adults on dialysis after an atherosclerotic cardiovascular event

Primary outcome

All-cause mortality

Effect

4-year risk difference -6.2% (95% CI -10.2 to -2.2); RR 0.88 (0.81-0.96)

A French registry study in Kidney International, published on 20 October 2026, used the REIN dialysis registry linked to national health data from 2010 to 2023. It included 5,534 adults on dialysis who had an atherosclerotic cardiovascular event, median age 75, and compared those who started a statin with those who did not, using weighting to balance baseline characteristics.

Statin initiation was associated with lower all-cause mortality. The largest absolute difference was at four years (risk difference -6.2%, 95% CI -10.2 to -2.2; relative risk 0.88). Mean survival gain was 69 days at five years and 135 days at ten years. Rhabdomyolysis and toxic hepatitis admissions did not differ.

Previous statin trials in dialysis were neutral but excluded recent events and mixed primary and secondary prevention. Current KDIGO guidance suggests not starting statins in dialysis patients, and that guidance has not changed on one observational study; but this fills a gap for the specific case of secondary prevention after an event.

• Consider a statin for a patient on dialysis after an atherosclerotic event, discussing the modest expected gain.
• Continue statins in patients already taking them when they start dialysis, in line with current guidance.
• Watch for muscle symptoms, though no excess rhabdomyolysis was seen here.
• Recognise that guidelines on starting statins in dialysis have not changed.

Why it matters

Dialysis patients are often left off statins after a heart attack because earlier trials were neutral in a different population.

Don't overread it

Observational data; it cannot exclude that healthier patients were the ones started on statins.

The statistics, in plain English

A relative risk of 0.88 is a modest reduction. The survival gain of about four months over ten years is an average across the group, not a guaranteed benefit for each patient.

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