Could High-Potency Statins Increase Risk of Acute Kidney Injury?

Full access

Patients taking high-potency statins may have a higher rate of hospitalization for acute kidney injury (AKI), according to a study in the British Medical Journal.

Drawing on nine population-based cohort studies and a meta-analysis from North America and the United Kingdom, the researchers analyzed data from more than two million adults (40 years or older) who began taking statin therapy between 1997 and 2008. Treatment with high-potency statins—rosuvastatin 10 mg or higher, atorvastatin 20 mg or higher, or simvastatin 40 mg or higher—was evaluated for association with hospitalization for AKI. Patient cohorts with and without chronic kidney disease (CKD) were analyzed, with each case matched to 10 controls.

Within 120 days after the start of statin therapy, there were 4691 hospitalizations for AKI in patients without CKD and 1896 in patients with CKD. In the non-CKD cohort, the risk of hospitalization for AKI was 34 percent higher for patients taking high-potency statins (compared with lower doses). For the CKD cohort, the 10 percent excess risk associated with high-potency statins was nonsignificant. An analysis of heterogeneity showed robust associations across study sites.

Previous studies have suggested possible adverse renal effects of lipid-lowering statin therapy. However, the specific nature of this relationship—including whether there is any dose–response effect—remains unclear.

The new study shows a possible increase in hospitalization for AKI among patients starting high-potency statin therapy, especially during the first few months. Although the absolute risk appears small, the association may have clinical implications for prescribing of high-potency statins, “particularly when treatment with a low potency statin is an option” [Dormuth CR, et al. Use of high potency statins and rates of admission for acute kidney injury: multicenter, retrospective observational analysis of administrative databases. BMJ 2013; 346:f880].