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High-potency statins may increase risk for kidney injury
Recent data demonstrate that use of high-potency statins increased the risk for acute kidney injury in patients by 34% compared with low-potency statin use.
Researchers in Canada conducted a retrospective, observational analysis of 2 million patients, aged 40 years or older, who were newly prescribed high-potency statins in seven Canadian provinces, the United States and the United Kingdom between 1997 and 2008 (mean age, 68 years; 50% women).
Colin R. Dormuth
High-potency statins were defined as those that produced a ≤45% reduction in LDL. Rosuvastatin (Crestor, AstraZeneca) at 10 mg or more, atorvastatin (Lipitor, Pfizer) at 20 mg or more and simvastatin at 40 mg or more were defined as high-potency statins.
Overall, 2,067,639 patients were newly exposed to statins. The researchers recorded 59,636 patients with chronic kidney injury using statins within 3 years before cohort entry. Within 120 days of treatment, 4,691 patients with non-chronic kidney disease were hospitalized for acute kidney injury and 1,896 were hospitalized with chronic kidney injury. Researchers found that high-potency statin users were 34% more likely to be hospitalized with acute kidney injury within 120 days compared with low-potency statin users. This risk remained elevated for 2 years after initiation (fixed-effect rate ratio=1.34; 95% CI, 1.25-1.43). Those who took high-potency statins with chronic kidney disease did not have as large an increase in admission rate (1.1).
“We estimate that 1,700 patients with non-chronic kidney disease need to be treated with a high-potency statin instead of a low-potency statin for 120 days to cause one additional hospitalization for acute kidney injury,” Colin R. Dormuth, MD, of the department of anesthesiology, pharmacology and therapeutics at the University of British Columbia, Canada, and colleagues wrote in the study.
Disclosure: Dormuth reports no relevant financial disclosures.
Perspective
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Cardiologists prescribe statins extensively with the knowledge that there are (rarely) serious adverse effects associated with use. What we have not been cognizant of is the potential risk for renal injury when higher doses of these agents are employed.
This is what the study by Dormuth et al suggests: ‘high-potency’ statin users are 34% more likely to be affected than ‘low-potency’ users and the risk remains elevated for at least 2 years after the 120-day treatment phase has ended. Although this was a retrospective, observational study, the large number of patients merits our attention.
One question, is it practical to try and replicate these results in a randomized clinical trial? In my opinion, l don't think so. We should learn to deal with this troublesome report as best we can. The only ‘good’ news is that 1,700 patients need to be treated with high statin doses to result in one additional case of acute renal injury.