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July 18, 2007

Statin Use and Sepsis in Patients With Chronic Kidney Disease

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;298(3):284-285. doi:10.1001/jama.298.3.284-a

To the Editor: Dr Gupta and colleagues1 found that the use of statins was independently associated with reduction in the risk of hospitalization for sepsis in patients with chronic kidney disease receiving dialysis. Several potential underlying mechanisms were invoked to explain an effect of statins, and we would like to add another possibility.

Statins increase the level of apolipoprotein (apo) A-I, the major protein component of high-density lipoprotein cholesterol, as well as the ratio of apo A-I to apo B.2 Apolipoprotein A-I has the ability to bind and clear lipopolysaccharide (endotoxin) and thereby protect against further lipopolysaccharide-induced cytokine activation.3 Furthermore, apo A-I can specifically block the interaction between activated T lymphocytes and monocytes, inhibiting production of tumor necrosis factor α and interleukin 1β in monocytes in the serum of healthy volunteers.4 As a clinical equivalent of this laboratory finding, we showed that a low serum level of apo A-I in critically ill patients at admission to intensive care was associated with exacerbation of the systemic inflammatory response syndrome.5 We also note that erythropoietin (often prescribed in patients with chronic kidney disease, but not detailed in the article) can increase apo A-I level.6