Condition category
Circulatory System
Date applied
Date assigned
Last edited
Retrospectively registered
Overall trial status
Recruitment status
No longer recruiting
Publication status

Contact information



Primary contact

Prof Colin Baigent


Contact details

Richard Doll Building
Old Road Campus
Roosevelt Drive
United Kingdom
+44 (0)1865 743 743

Additional identifiers

EudraCT number

2004-001156-37 number


Protocol/serial number


Study information

Scientific title

A randomised controlled trial of ezetimibe and simvastatin versus placebo to reduce low density lipoprotein cholesterol in patients with chronic kidney disease



Study hypothesis

Reducing low density lipoprotein (LDL) cholesterol will reduce the risk of major vascular events in patients with chronic kidney disease and may delay progression to end-stage renal disease.

Protocol can be found at:

Ethics approval

Thames Valley MREC (Multicentre Research Ethics Committee), 25/04/2003, ref: 02/12/022

Study design

Randomised controlled trial

Primary study design


Secondary study design

Randomised controlled trial

Trial setting

Not specified

Trial type


Patient information sheet

Not available in web format, please use the contact details to request a patient information sheet


Prevention of vascular disease in chronic kidney disease patients


Following a 6-week run-in phase, participants are initially randomised to:
Arm 1: placebo, OR
Arm 2: ezetimibe 10 mg + simvastatin 20 mg daily, OR
Arm 3: simvastatin 20 mg daily (1 year only of treatment with simvastatin, then re-randomisation of Arm 3 participants to placebo [Arm 3a] or ezetimibe + simvastatin [Arm 3b]

Follow-up is scheduled to continue until all participants have been followed up for at least 4 years, regardless of whether they are continuing to take study treatment.

Intervention type



Not Applicable

Drug names

Ezetimibe, simvastatin

Primary outcome measure

Major vascular events (defined as non-fatal myocardial infarction or cardiac death, non-fatal or fatal stroke, or revascularisation) at end of study

Please note, in October 2009, the Steering Committee decided to change the primary outcome to major atherosclerotic events, defined as the combination of MI, coronary death, ischaemic stroke, or any revascularization procedure (ie, exclusion of non-coronary cardiac deaths and strokes confirmed to be haemorrhagic from the original major vascular event outcome). The independent sponsor (University of Oxford) was required by its contract with the main funder (Merck/Schering-Plough) to seek its formal agreement to any protocol change, but the funder declined to approve the changes agreed by the Steering Committee. Although it was therefore not possible to revise the protocol accordingly, the Steering Committee was free to change the statistical analysis plan as it considered appropriate whilst it remained blind to the effects of treatment on efficacy end points. The 'key outcome' was therefore changed to 'Major Atherosclerotic Events' by the Steering Committee whilst still blind to the effects of treatment on clinical outcomes. This is described in the following paper: SHARP Collaborative Group. Study of Heart and Real Protection (SHARP): Randomized trial to assess the effects of lowering low-density lipoprotein cholesterol among 9,438 patients with chronic kidney disease. Am Heart J 2010; 160: 785-94 (

Secondary outcome measures

1. Major vascular events at end of study
2. Major cardiac events (non-fatal myocardial infarction [MI] or cardiac death) at end of study
3. Stroke (fatal or non-fatal) at end of study
4. Coronary or non-coronary revascularisation at end of study
5. Mortality, both overall and within particular categories at end of study
6. Hospital admission for angina at end of study
7. End-stage renal disease (need for long-term dialysis or transplantation) at end of study
8. End-stage renal disease or death from any cause at end of study

Overall trial start date


Overall trial end date


Reason abandoned (if study stopped)


Participant inclusion criteria

1. History of chronic kidney disease (CKD): either patients who are pre-dialysis (with a plasma or serum creatinine greater than or equal to 150 µ/l [greater than or equal to 1.7 mg/dl] in men, or greater than or equal to 130 µ/l [greater than or equal to 1.5 mg/dl] in women); or patients on dialysis (haemodialysis or peritoneal dialysis)
2. Men or women aged greater than or equal to 40 years

Participant type


Age group




Target number of participants

9000 (actual number recruited: 9438; last patient visit on 19/08/2010)

Participant exclusion criteria

1. Definite history of myocardial infarction or coronary revascularisation procedure
2. Functioning renal transplant, or living donor-related transplant planned
3. Less than 2 months since presentation as an acute uraemic emergency (but may be entered later, if appropriate)
4. Definite history of chronic liver disease, or abnormal liver function (i.e. alanine aminotransferase [ALT] >1.5 x upper limit of normal [ULN] or, if ALT not available, aspartate aminotransferase [AST] >1.5 x ULN). (Note: Patients with a history of hepatitis are eligible provided these limits are not exceeded).
5. Evidence of active inflammatory muscle disease (e.g. dermatomyositis, polymyositis), or creatine kinase (CK) >3 x ULN
6. Definite previous adverse reaction to a statin or to ezetimibe
7. Concurrent treatment with a contraindicated drug (Note: Patients who are temporarily taking such drugs may be re-screened for participation in the study when they discontinue them, if appropriate). These contraindicated drugs include:
a. HMG-CoA reductase inhibitor ('statin')
b. Fibric acid derivative ('fibrate')
c. Nicotinic acid
d. Macrolide antibiotic (erythromycin, clarithromycin)
e. Systemic use of imidazole or triazole antifungals (e.g. itraconazole, ketoconazole)
f. Protease-inhibitors (e.g. antiretroviral drugs for human immunodeficiency virus [HIV] infection)
g. Nefazodone
h. Ciclosporin
8. Child-bearing potential (i.e. premenopausal woman who is not using a reliable method of contraception)
9. Known to be poorly compliant with clinic visits or prescribed medication
10. Medical history that might limit the individual's ability to take trial treatments for the duration of the study (e.g. severe respiratory disease, history of cancer other than non-melanoma skin cancer, or recent history of alcohol or substance misuse)

Recruitment start date


Recruitment end date



Countries of recruitment

Australia, Austria, Canada, China, Czech Republic, Denmark, Finland, France, Germany, Malaysia, Netherlands, New Zealand, Norway, Poland, Sweden, Thailand, United Kingdom, United States of America

Trial participating centre

United Kingdom

Sponsor information


University of Oxford (UK)

Sponsor details

University Offices
Wellington Square
United Kingdom

Sponsor type




Funder type


Funder name

Merck Schering-Plough (UK)

Alternative name(s)

Funding Body Type

Funding Body Subtype


Results and Publications

Publication and dissemination plan

Not provided at time of registration

Intention to publish date

Participant level data

Not provided at time of registration

Basic results (scientific)


Publication list

2010 results in:
2011 results in:
2017 results in:
2018 protocol for 5-year follow-up study in: (added 31/10/2019)

Publication citations

  1. Results

    Sharp Collaborative Group, Study of Heart and Renal Protection (SHARP): randomized trial to assess the effects of lowering low-density lipoprotein cholesterol among 9,438 patients with chronic kidney disease., Am. Heart J., 2010, 160, 5, 785-794.e10, doi: 10.1016/j.ahj.2010.08.012.

  2. Results

    Baigent C, Landray MJ, Reith C, Emberson J, Wheeler DC, Tomson C, Wanner C, Krane V, Cass A, Craig J, Neal B, Jiang L, Hooi LS, Levin A, Agodoa L, Gaziano M, Kasiske B, Walker R, Massy ZA, Feldt-Rasmussen B, Krairittichai U, Ophascharoensuk V, Fellström B, Holdaas H, Tesar V, Wiecek A, Grobbee D, de Zeeuw D, Grönhagen-Riska C, Dasgupta T, Lewis D, Herrington W, Mafham M, Majoni W, Wallendszus K, Grimm R, Pedersen T, Tobert J, Armitage J, Baxter A, Bray C, Chen Y, Chen Z, Hill M, Knott C, Parish S, Simpson D, Sleight P, Young A, Collins R, , The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial., Lancet, 2011, 377, 9784, 2181-2192, doi: 10.1016/S0140-6736(11)60739-3.

Additional files

Editorial Notes

31/10/2019: Publication reference added. 04/05/2017: Publication reference added. 28/09/2010: The overall trial end date was changed from 31/08/2010 to 02/09/2010. 10/02/2009: The overall trial end date was changed from 31/07/2010 to 31/08/2010.