Effect of pravastatin on rate of kidney function loss in people with or at risk for coronary disease.
BACKGROUND
Limited data suggest that HMG-CoA reductase inhibitors (statins) reduce rates of kidney function loss. We performed this analysis to determine whether pravastatin reduced the rate of kidney function loss over approximately 5 years in people with or at high risk for coronary disease.


RESULTS
This was a post hoc subgroup analysis of data from 3 randomized double-blind controlled trials comparing pravastatin 40 mg/d and placebo in subjects with a previous acute coronary syndrome or who were at high cardiovascular risk. The primary outcome was the rate of change in estimated glomerular filtration rate (GFR; in mL/min per 1.73 m2/y). The Modified Diet and Renal Disease Study (MDRD) and Cockcroft-Gault equations were used to estimate GFR. We studied 18,569 participants, 3402 (18.3%) of whom had moderate chronic kidney disease as defined by an estimated GFR of 30 to 59.9 mL/min per 1.73 m2 body surface area. In subjects with moderate chronic kidney disease at baseline, pravastatin reduced the adjusted rate of kidney function loss by approximately 34%, although the absolute reduction in the rate of loss was small (0.22 mL/min per 1.73 m2/y by MDRD-GFR; 95% CI, 0.07 to 0.37). Pravastatin did not reduce the frequency of > or =25% decreases in kidney function in this group when MDRD-GFR was used to estimate GFR (relative risk [RR], 0.84; 95% CI, 0.66 to 1.06). When all 18,569 subjects were considered, pravastatin reduced the adjusted rate of kidney function loss by 8% (0.08 mL/min per 1.73 m2/y by MDRD-GFR; 95% CI, 0.01 to 0.15) and the risk of acute renal failure (RR, 0.60; 95% CI, 0.41 to 0.86) but did not significantly reduce the frequency of a > or =25% decline in kidney function by MDRD-GFR (RR, 0.94; 95% CI, 0.88 to 1.01).


CONCLUSIONS
Pravastatin modestly reduced the rate of kidney function loss in people with or at risk for cardiovascular disease. However, the primary indication for the use of statins in people with or at risk for coronary events remains the reduction in mortality that results from their use.
Tonelli
Marcello
M
Division of Nephrology and Division of Critical Care Medicine, University of Alberta, and Institute of Health Economics, Edmonton, Alberta, Canada. mtonelli@ualberta.ca
Isles
Chris
C
Craven
Timothy
T
Tonkin
Andrew
A
Pfeffer
Marc A
MA
Shepherd
James
J
Sacks
Frank M
FM
Furberg
Curt
C
Cobbe
Stuart M
SM
Simes
John
J
West
Malcolm
M
Packard
Chris
C
Curhan
Gary C
GC
D000368:Aged; D002908:Chronic Disease; D003327:Coronary Disease / Q000188:drug therapy* / Q000453:epidemiology; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy* / Q000453:epidemiology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D017035:Pravastatin / Q000494:pharmacology* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000188:drug therapy / Q000517:prevention & control*; D012189:Retrospective Studies; D012306:Risk
D017035:Pravastatin