Background: It has been suggested that hyperlipidemia contributes to the progression of kidney disease and there are some experimental reports that support the hypothesis of lipid nephrotoxicity. The treatment of hyperlipidemia in patients with renal disease has two purposes: to prevent the development of cardiovascular disease and to prevent the progression of renal disease. However, statins, which are widely used to treat hyperlipidemia, should be used very carefully in patients with renal disease, especially in those whose serum creatinine level is more than 3 mg/dL. Atorvastatin, an HMG-CoA reductase inhibitor, is completely metabolized in the liver. Thus, we thought that atorvastatin could be used safely in hyperlipidemic patients with chronic renal disease.
Patients and methods: Atorvastatin was administered to 84 hyperlipidemic patients with chronic renal disease(including dialysis patients) for 12 months. TC, TG, LDL-C, AST, ALT, CK, BUN, and Cr were measured at 3, 6, and 12 months during treatment. Blood pressure and renal function, as indicated by urinary protein excretion and creatinine clearance measured at 0 and 12 months during treatment, were also monitored.
Results: TC and LDL-C were decreased at every determination point regardless of the kidney function, which was not affected by atorvastatin. Urinary protein excretion (UP) decreased significantly during the study period in patients who had not taken any anti-hyperlipidemic drug before treatment with atorvastatin. This decrease in UP was not associated with significant Ccr change. However, the decrease in UP was not statistically significant in all the patients. The decrease in UP showed a significant positive correlation with the decrease in TC and of the mean BP.
Conclusion: Atorvastatin can be used safely in hyperlipidemic patients with chronic renal disease including dialysis patients under periodical monitoring. Atorvastatin could contribute to prevent the progression of renal disease.