Abstract 532: Effect of 3-hydroxy-3-methylglutaryl-CoA Reductase Inhibitors on Renal Function
Background: 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors (statins) reduce serum cholesterol, and cardiovascular morbidity and mortality. The role of lipids in the progression of kidney disease and the potential beneficial effects of statins on renal function is unknown. Oxidative stress and inflammation may be the missing link between CAD and chronic kidney disease. Statins may protect the kidney through both lipid lowering properties and pleiotropic effects.
Methods: We analyzed data in 197, 551 patients (mean age 64.8 ± 13.6 years, 95% males, 29.5% (58,332) statin users, and 70.5% (139, 219) non-statin users), who had baseline creatinine less than 3.5 mg/dl, from the cross-sectional data mined from the Veterans Affairs VISN 16 database. Deterioration of renal function was defined as doubling of the baseline or increase in creatinine of 0.5 mg/dl over at least 90 days.
Results: Based on this definition, 3.4% of patients developed renal deterioration over 5 year of follow-up. After adjustment for demographics, diabetes mellitus, smoking, and other medications (especially use of angiotensin-converting enzyme inhibitors, calcium channel blockers and aspirin, all of which were confounders of the statin-renal deterioration relationship), use of statins reduced the odds of deterioration in renal function by 15% (OR 0.85, 95% CI = 0.80 – 0.89, p < 0.0001). This effect was independent of cholesterol lowering effect of statins. Impact of other variables was as follows: age (OR = 1.04, CI = 1.03–1.04, p < 0.0001), diabetes (OR = 1.76, CI = 1.67–1.85, p < 0.0001), and smoking (OR = 1.76, CI = 1.05–1.23, p = 0.0014).
Conclusion: Statin use may retard the progression of renal disease. Although the precise mechanism is not known, lowering of LDL-cholesterol and improvement in endothelial function by statins may relate to reno-protective effect.