How helpful are statins at lowering CVD mortality in patients with renal disease and are they safe in renal failure? This article provides answers.

Has cardiovascular mortality increased in CKD patients?

An elevated risk of cardiovascular death is seen in patients with CKD. The presence of dyslipidemia is also a critical risk factor for cardiovascular disease in patients with kidney disease. The decreases in major cardiovascular events due to statins is proportional to reductions in LDLc levels in patients with CKD who aren't on dialysis. The Heart and Renal Protection Study (SHARP) and meta-analysis of RCTs in patients with CKD showed that, compared to placebo, pitavastatin and pravastatin may reduce albuminuria.

Is it possible to use statins to delay the loss of renal function?

The impact of statins on renal function preservation are not yet well understood and appear to vary depending on the type of statin used. In people with chronic kidney disease, atorvastatin, but not rosuvastatin, may have renoprotective effects. However, the SHARP study concluded that simvastatin/ezetimibe is not associated with a synergistic effect in reducing renal function loss.

In patients receiving dialysis, are statins effective in preventing cardiovascular disease?

The effectiveness of statins in preventing cardiovascular events in dialysis-treated patients is questionable. Both the Die Deutsche Diabetes Dialyse Studie and AURORA study, provide strong evidence suggesting that patients who are already on dialysis do not improve from initiating statin therapy. However, the Brazilian guidelines for the prevention of cardiovascular disease in patients with diabetes recommend that statin therapy should not be suspended when dialysis is initiated in patients who are already using statins. In a retrospective cohort study of 14,298 participants, patients who were on a statin and continued to use it for at least six months had a 28 per cent reduced risk of death during the first year of dialysis.

In case of renal failure, are statins safe?

The majority of statins are dependent upon renal excretion. Inadequate renal function could ultimately lead to an increased level of systemic exposure with the potential for toxicity. However, renal excretion is generally low, with the exception of pravastatin. Statins are well tolerated in CKD, and renal function dose adjustments should be followed to prevent adverse events.

This is the third in the series on statins. Click on the following links to read the previous articles in the series.

Is it safe for patients with heart failure to use statins?

Can statins induce new-onset diabetes?

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author, Dr. Monish S Raut is a Consultant in Cardiothoracic Vascular Anaesthesiology. His area of expertise is perioperative management and echocardiography with numerous publications in various national and international indexed journals.