Atthobari J 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

The effectiveness of statins in cardiovascular care is well recognized. Experimental studies and some human trials—mostly in people at high risk and with high cholesterol levels—also indicate a positive effect on renal outcomes. Data from subjects with a modestly impaired glomerular filtration rate (GFR) and an elevated urinary albumin excretion (UAE) rate are less promising, with statins failing to lower UAE rate or significantly change GFR in these individuals.

Atthobari et al. used data from the randomized controlled PREVEND-IT and the PREVEND cohort study, which enrolled subjects with modest renal impairment (stages 1–3 chronic kidney disease). The observational PREVEND cohort comprised 3,440 subjects. Over a mean 4.2-year follow-up, statin use (n = 469) significantly increased UAE compared with no statin use (+12.1% vs +3.6%), even after adjustment for confounders and propensity score (P <0.001). This rise was greatest in those who used statins continuously, for a long period of time, or at high daily doses, indicating interference of statins with tubular albumin uptake. In PREVEND-IT, which enrolled 864 PREVEND subjects with UAE 15–300 mg/day, pravastatin did not significantly affect UAE when administered with or without fosinopril. Statins had little effect on GFR in either study, although there was a modest fall in this marker in the observational cohort that was nonsignificant following adjustment. These and other data indicate that the positive effect of statins on renal function might be greatest in those with more-severe kidney impairment.