Widely used cholesterol medicine tied to modestly greater kidney risks

A large analysis of medical records found that people who began taking rosuvastatin had slightly higher rates of certain kidney-related problems than those who started atorvastatin. The results highlight the importance of considering kidney function when selecting and dosing statins.

Rosuvastatin and atorvastatin are both statins, a class of drugs used to lower LDL cholesterol and cut the risk of heart attack and stroke. Doctors may favor one medication over the other depending on how much cholesterol reduction is needed and on a patient’s other medical conditions.

A research team led by Johns Hopkins published the analysis in the Journal of the American Society of Nephrology. It reviewed records for 152,101 people who started rosuvastatin and 795,799 who started atorvastatin between 2011 and 2019.

Over a median follow-up of a little more than three years, 2.9% of patients in the two groups combined had blood in their urine, and 1% had protein in their urine. Either finding can have several causes and does not necessarily mean kidney failure.

After adjusting for measurable differences between the groups, the researchers reported an 8% higher relative rate of blood in the urine among rosuvastatin users. The relative rate of protein in the urine was 17% higher.

Kidney failure requiring dialysis or a transplant was less common than those urine findings. The relative rate of kidney failure was estimated to be 15% higher in the rosuvastatin group, which is a comparison between groups rather than the share of patients who actually developed kidney failure.

Higher rosuvastatin doses were linked with greater risks of blood or protein in the urine. The researchers also found that among patients with severely reduced kidney function, 44% began rosuvastatin at 20 or 40 milligrams a day.

Those doses were above the 10-milligram daily maximum listed in U.S. labeling for severe kidney disease, according to the researchers. That raises a prescribing concern in addition to the broader comparison between the two medicines.

Cardiovascular outcomes were broadly similar in both groups. The study also separated urine abnormalities from kidney failure, which helped show how the comparison differed by outcome severity. Because the drugs and doses were chosen in routine care, however, differences in patient health or treatment patterns could still affect the results even after statistical adjustment.

The findings describe average differences across a large population. They cannot show whether a particular abnormal urine test was caused by a statin or predict what would happen if an individual patient switched treatments.

The study suggests clinicians should weigh kidney function, dose, and cardiovascular benefit together when reviewing treatment. A medication review can help address those issues while keeping cholesterol control in focus.

If you are interested in this topic, please read articles about A Constipation Drug May Help Treat Chronic Kidney Disease, and How High Blood Pressure Can Damage Your Kidneys and Heart Without Warning.

For more information, please see articles about This Drug May Lower Cholesterol and Heart Disease Risk, and Gum Disease Could Affect Your Kidney Health.

Source: Johns Hopkins Bloomberg School of Public Health.