Evidence map›Statins × kidney outcomes›PMID 19540640›Full record

Trial reportAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2009

Effects of atorvastatin on kidney outcomes and cardiovascular disease in patients with diabetes: an analysis from the Collaborative Atorvastatin Diabetes Study (CARDS).

Helen M Colhoun, D John Betteridge, Paul N Durrington, Graham A Hitman, H Andrew W Neil, Shona J Livingstone, Valentine Charlton-Menys, David A DeMicco, John H Fuller, CARDS Investigators

Abstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in American journal of kidney diseases : the official journal of the National Kidney Foundation, 2009. The graph read 3 numbers from its abstract, feeding 1 cell of the map: it finds no clear difference in 1. Cited by 89 papers, 9 of them syntheses that pooled it.

3numbers the graph read from it
1cell of the map it votes in
89citing papers in PubMed, 9 pooled it
18.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

← favours the treatmentfavours the comparator →
0.521 · no effect
Kidney outcomesno clear difference · against placebo · ckd, dyslipidemiafeeds one cell of the map
HR 1.190.57 to 2.49P = 0.6
Atorvastatin did not influence the incidence of albuminuria (hazard ratio, 1.49; 95% CI, 0.73 to 3.04; P = 0.3) or regression to normoalbuminuria (hazard ratio, 1.19; 95% CI, 0.57 to 2.49; P = 0.6).
FeedsStatins×kidney outcomes
Kidney outcomesno clear difference · against placebo · ckd, dyslipidemiafeeds one cell of the map
HR 1.490.73 to 3.04P = 0.3
Atorvastatin did not influence the incidence of albuminuria (hazard ratio, 1.49; 95% CI, 0.73 to 3.04; P = 0.3) or regression to normoalbuminuria (hazard ratio, 1.19; 95% CI, 0.57 to 2.49; P = 0.6).
FeedsStatins×kidney outcomes

Read, but not usablea number the graph found but could not read as for or against

Kidney outcomesdirection of benefit for this outcome is not defined · against placebo · ckd, dyslipidemiafeeds one cell of the map
treatment effect 37.017.0 to 52.0P < 0.001
This treatment effect was similar to the 37% (95% CI, 17 to 52; P < 0.001) reduction in CVD observed in the study overall (P = 0.4 for the eGFR-treatment interaction).
FeedsStatins×kidney outcomes

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Statins×kidney outcomes

InconclusiveOpen on the map →What to test next →

4 readable studies in this cell: 0 favour the treatment, 3 find no difference, 1 favour the comparator.

Belief with this paper
0.00contested · 0 families support, 1 contradict · against placebo
Without it
0.00This paper does not move the number.
← favours the treatmentfavours the comparator →
1 · no effect
This paper · 2009
HR 1.190.57 to 2.49
NCT023442907,769 enrolled · 2015
HR 0.600.14 to 2.51
Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Pr…PMID 26597925 · 2016
RR 0.970.90 to 1.03
Adverse events associated with unblinded, but not with blinded, statin…PMID 28476288 · 2017
HR 1.231.08 to 1.41
4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

89 citing papers in PubMed, 9 syntheses or guidelines pooled it, 252 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Statins and Cardiovascular Primary Prevention in CKD: A Meta-Analysis.Clinical journal of the American Society of Nephrology : CJASN · 2015 · on this map
    Pooled it
  7. Guideline
  8. Statins for the primary prevention of cardiovascular disease.The Cochrane database of systematic reviews · 2013 · on this map
    Pooled it
  9. Pooled it
  10. Trial
  11. Trial
  12. Trial
  13. Trial
  14. Trial
  15. Trial
  16. Trial
  17. Trial
  18. Current perspectives on lipid management in diabetic kidney disease: Can fibrates offer advantages over statins for renal outcomes?Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences · 2026
    Review
  19. Article
  20. Article

29 more citing papers are in PubMed but not listed here.

6 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

7 · Who and what money

Authors and funding

10 authors at 5 institutions in 2 countries.

Helen M ColhounBiomedical Research Institute, University of Dundee, Dundee, Scotland, UK. h.colhoun@cpse.dundee.ac.uk
D John Betteridge
Paul N Durrington
Graham A Hitman
H Andrew W Neil
Shona J Livingstone
Valentine Charlton-Menys
David A DeMicco
John H Fuller
CARDS Investigators
University College London · GBUniversity of Dundee · GBUniversity of Manchester · GBOxford Centre for Diabetes, Endocrinology and Metabolism · GBPfizer (United States) · US

Funding

Department of Health
8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundWe examined whether atorvastatin affects diabetic kidney disease and whether the effect of atorvastatin on cardiovascular disease (CVD) varies by kidney status in patients with diabetes. STUDY

designThe Collaborative Atorvastatin Diabetes Study (CARDS) randomized placebo-controlled trial. SETTING &

participantsPatients with type 2 diabetes and no prior CVD (n = 2,838).

interventionRandom allocation to atorvastatin, 10 mg/d, or placebo, with a median follow-up of 3.9 years. OUTCOMES: Estimated glomerular filtration rate (eGFR), albuminuria, CVD. MEASUREMENTS: Baseline and follow-up GFRs were estimated by using the Modification of Diet in Renal Disease Study equation. Urinary albumin-creatinine ratio was measured on spot urine samples.

resultsAt baseline, 34% of patients had an eGFR of 30 to 60 mL/min/1.73 m(2). Atorvastatin treatment was associated with a modest improvement in annual change in eGFR (net, 0.18 mL/min/1.73 m(2)/y; 95% confidence interval [CI], 0.04 to 0.32; P = 0.01) that was most apparent in those with albuminuria (net improvement, 0.38 mL/min/1.73 m(2)/y; P = 0.03). At baseline, 21.5% of patients had albuminuria and an additional 6.8% developed albuminuria during follow-up. Atorvastatin did not influence the incidence of albuminuria (hazard ratio, 1.49; 95% CI, 0.73 to 3.04; P = 0.3) or regression to normoalbuminuria (hazard ratio, 1.19; 95% CI, 0.57 to 2.49; P = 0.6). In 970 patients with a moderately decreased eGFR of 30 to 60 mL/min/1.73 m(2), there was a 42% reduction in major CVD events with treatment, including a 61% reduction in stroke. This treatment effect was similar to the 37% (95% CI, 17 to 52; P < 0.001) reduction in CVD observed in the study overall (P = 0.4 for the eGFR-treatment interaction). LIMITATIONS: Low incidence rates of albuminuria and transition to more severe kidney status limit power to detect treatment effects.

conclusionsA modest beneficial effect of atorvastatin on eGFR, particularly in those with albuminuria, was observed. Atorvastatin did not influence albuminuria incidence. Atorvastatin was effective at decreasing CVD in those with and without a moderately decreased eGFR and achieved a high absolute benefit.

Indexed as

AgedAlbuminuriaAtorvastatinCardiovascular DiseasesDiabetes Mellitus, Type 2Diabetic NephropathiesFemaleGlomerular Filtration RateHeptanoic AcidsHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedPyrrolesAtorvastatinHeptanoic AcidsHydroxymethylglutaryl-CoA Reductase InhibitorsPyrroles

Identifiers

PMID19540640
OpenAlexW2029977823

What OpenQuestion holds

Texttitle and abstract
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.