NDT Advance Access originally published online on January 25, 2007
Nephrology Dialysis Transplantation 2007 22(3):963-964; doi:10.1093/ndt/gfl802
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Statins and renal function. Is the compound and dose making a difference?
Email: athyros{at}med.auth.grSir,
Atthobari et al. [1] conclude that statin (pravastatin) treatment was not associated with a significant improvement in glomerular filtration rate (GFR) in subjects with modestly impaired GFR. This conclusion deserves some debate.
The Heart Protection Study showed that allocation to simvastatin significantly attenuated the fall in estimated GFR (e-GFR) in diabetic and non-diabetic subjects compared with placebo [2]. A pooled analysis of the Cholesterol And Recurrent Events, Long-term Intervention with Pravastatin in Ischemic Disease and West Of Scotland Coronary Prevention Study trials comparing pravastatin vs placebo also showed a decreased deterioration of renal function [3]. In the GREek atorvastatin and coronary heart disease evaluation (GREACE) study, atorvastatin treatment significantly increased e-GFR and reduced serum uric acid levels, whereas renal function deteriorated in untreated patients [4,5,6]. In GREACE [4,5,6], the effect on renal function was rapid, more evident in patients with serum creatinine levels at the upper end of the reference range, more pronounced at higher doses of atorvastatin used (10–80 mg/day) and contributed to the reduction in vascular events (multivariate analysis). The results of a post hoc analysis of the Treating to New Targets trial showed that instead of the expected decline of about 5 ml/min over the 5 year study period, there was a significant increase in e-GFR with both the 10 mg/day (by 5.6%) and the 80 mg/day dose of atorvastatin (by 8.4%) [7].
Thus, the effect of statins on renal function may depend on the statin used, the extent of hypolipidaemic effect and the patient category. These factors need to be resolved to ensure the provision of best treatment. Given that renal and coronary disease may progress in parallel, [4,5,6] appropriate statin treatment at appropriate dosing may be beneficial to both the heart and kidneys.
1Atherosclerosis and Metabolic
Syndrome Units
2nd Propedeutic
Department of Internal Medicine
Aristotelian University
Hippocration Hospital
Thessaloniki
2Department of Internal Medicine
Medical School
University of Ioannina
Greece
3Department of Clinical Biochemistry
(Vascular Disease Prevention Clinics)
Royal Free Hospital
Royal Free and University College Medical School
London
UK
References
- Atthobari J, Brantsma AH, Gansevoort Rt, et al. (2006) The effect of statins on urinary albumin excretion and glomerular filtration rate: results from both a randomized clinical trial and an observational cohort study. Nephrol Dial Transplant 21:3106–3114.
[Abstract/Free Full Text] - Collins R, Armitage J, Parish S, et al. (2003) MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet 361:2005–2016.[CrossRef][ISI][Medline]
- Tonelli M, Isles C, Craven T, et al. (2005) Effect of pravastatin on rate of kidney function loss in people with or at risk for coronary disease. Circulation 112:171–178.[ISI][Medline]
- Athyros VG, Mikhailidis DP, Papageorgiou AA, et al. (2004) The effect of statins vs untreated dyslipidemia on renal function in patients with coronary heart disease: a subgroup analysis of the Greek atorvastatin and coronary heart disease evaluation (GREACE) study. J Clin Pathol 57:728–734.
[Abstract/Free Full Text] - Athyros VG, Elisaf M, Papageorgiou AA, et al. (2004) GREACE Study Collaborative Group. Effect of statins vs untreated dyslipidemia on serum uric acid levels in patients with coronary heart disease: a subgroup analysis of the GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) study. Am J Kidney Dis 43:589–599.[CrossRef][ISI][Medline]
- Athyros VG, Mikhailidis DP, Liberopoulos EN, et al. (2006) Effect of statin treatment on renal function and serum uric acid levels and their relation to vascular events in patients with coronary heart disease and metabolic syndrome: a subgroup analysis of the GREek Atorvastatin and Coronary heart disease Evaluation (GREACE) Study. Nephrol Dial Transplant [Epub ahead of print].
- Shepherd J and Wenger N. for the TNT Steering Committee and Investigators. Intensive lipid lowering with atorvastatin is associated with a significant improvement in renal function: The Treating to New Targets (TNT) Study. American College of Cardiology 2006 Scientific Sessions13 March 2006Atlanta, GA pp. 808–813 Abstract.
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