Effect of atorvastatin on kidney function in chronic kidney disease: A randomised double-blind placebo-controlled trial

Background: The effect of atorvastatin on kidney function was assessed in patients with stages 2-4 chronic kidney disease. Methods: We conducted a randomised, double-blind, placebo-controlled trial in chronic kidney disease clinics in Northern Tasmania and enrolled 132 patients with serum creatinine levels >120 mu mol/l, not taking lipid-lowering therapy and at all levels of proteinuria and serum cholesterol. Patients were randomly assigned to receive either 10 mg of atorvastatin/day (64) or placebo (68) and were followed with trial visits 3-monthly for a mean of 2.5 yrs. The primary outcome was the rate of both MDRD eGFR and Cockcroft-Gault creatinine clearance (C-G CrCl) decline. Analysis was based on intention to treat and included all patients that had at least one follow-up visit. Results: The rate of MDRD eGFR decline was 29% lower; 1.04 +/- 3.84 vs. 1.47 +/- 3.74 ml/min/1.73m(2)/yr (P = 0.53), and the C-G CrCl was 20% lower; 1.88 +/- 5.07 vs. 2.36 +/- 4.61 ml/min/1.73m(2)/yr (P = 0.58) in atorvastatin-treated, compared with placebo-treated patients. Although blood pressure decreased in both atorvastatin and placebo-treated groups there were no differences between groups. In addition, there was no difference in concomitant medication intake including angiotensin converting enzyme inhibitors and angiotensin receptor blockers between groups. Conclusions: There was a trend toward a slower eGFR decline in the atorvastatin-treated group that did not reach statistical significance. This may have been due to the lack of power of the study. However, atorvastatin may have a renoprotective effect in those patients with chronic kidney disease and cardiovascular disease. This needs to be assessed in further studies. (C) 2010 Elsevier Ireland Ltd. All rights reserved.