Purpose of review: This paper outlines evidence for the putative renal benefits of statins in people with vascular disease. Recent findings: The Greek Atorvastatin and Coronary Heart Disease study showed a modest improvement in kidney function over 4 years among 800 atorvastatin recipients (12%), significantly better than the decrease in kidney function (4%) in 800 placebo recipients. A secondary analysis of the Cholesterol and Recurrent Events trial suggested that pravastatin reduced the rate of kidney function loss to a greater extent in participants with dipstick-positive proteinuria (P < 0.001) and lower levels of renal function at baseline (P = 0.04). A larger post-hoc analysis from this group found that pravastatin modestly reduced the risk of acute renal failure (RR 0.60, 95% CI 0.41-0.86), but not the risk of a 25% decline in kidney function from baseline (RR 0.94, 95% CI 0.88-1.01). In the group with lower baseline kidney function (glomerular filtration rate <60 ml/min/1.73 m2) and proteinuria on dipstick urinalysis (n = 249), pravastatin recipients were less likely to experience a 25% or greater decrease in glomerular filtration rate (12.5% versus 19.9%) or acute renal failure (3.2% versus 8.7%). Summary: Statins may reduce the rate of kidney function loss in people with cardiovascular disease, although the clinical significance of this effect is unclear. Future studies are required before statins can be recommended solely to protect renal function.

Department of Medicine University of Alberta Edmonton

Effect of statins on preservation of kidney function in patients with coronary artery disease

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