Some research supports statin use for people with kidney disease or kidney failure and heart disease. Other research recommends caution for those with kidney issues.
Heart disease is a major cause of death for people with chronic kidney disease (CKD). People with CKD often have risk factors for heart disease, too, which is why medications to control cholesterol and blood pressure are often prescribed.
Statins are recommended for people at an increased risk of heart disease, but people with CKD are at a great risk of side effects from these cholesterol-lowering drugs.
People living with severe kidney failure who don’t receive a kidney transplant have dialysis treatment.
Doctors will also prescribe medications to treat other conditions associated with kidney failure, including drugs that:
- lower blood pressure
- manage blood sugar
- lower cholesterol
- treat anemia
- relieve swelling from retaining fluids
Statins are among the most well-studied and
High levels of LDL (“bad”) cholesterol may build up and block your blood vessels. Statins work to prevent this by
A 2019 review of statins for the prevention of coronary heart disease in people who don’t already have a history of heart-related conditions (primary prevention) shows that they effectively decrease the occurrence of:
- angina
- myocardial infarction (heart attack)
- any coronary heart events
- coronary revascularization
- any cardiovascular (heart) events
According to the 2018 American Heart Association (AHA) cholesterol clinical practice guidelines, statin therapy for the secondary prevention of heart-related conditions (for people at risk for heart-related issues) also
A 2018 research review citing past studies found that for people with CKD not requiring dialysis and without heart disease, statins consistently:
- prevented major cardiovascular events
- lowered mortality
The same study, however, also presented data that argued against statin use, noting that:
- Long-term statin use may cause an increased rate of acute and chronic renal (kidney) disease.
- High efficacy statins are associated with a 13% increased risk of developing severe renal failure, including those at risk for ischemic heart disease, diabetes, and CKD.
More research is still needed, particularly studies focusing on people with kidney disease or kidney failure.
Getting a statin prescription
Doctors carefully weigh the benefits of statin therapy against the risks for people with kidney failure. They’ll consider your degree of kidney disease when prescribing a statin.
Depending on your stage of CKD, and especially if you have heart disease, you’ll likely be prescribed a statin. However, those on dialysis may not necessarily be prescribed a statin.
AHA guideline recommendations
Here are the AHA and American College of Cardiology 2018 guidelines for statin therapy for people with CKD:
| Age group | CKD stage | Treatment recommendation |
|---|---|---|
| Adults with clinical ASCVD | 1 to 5 (not on dialysis) | high intensity statin preferred moderate intensity statin if not a candidate for high intensity |
| Adults with LDL cholesterol at least 190 mg/dL | 1 to 5 (not on dialysis) | high intensity statin preferred moderate intensity statin if not a candidate for high intensity |
| Adults 40 to 75 years with diabetes and LDL cholesterol 70 to 189 mg/dL (no ASCVD) | 1 to 5 (not on dialysis) | high intensity statin if estimated 10-years ASCVD risk is at least 7.5% moderate intensity statin if not a candidate for high intensity |
| Adults with dialysis-dependent CKD and people with a kidney transplant | 5 (hemodialysis or peritoneal dialysis) | no recommendation |
Statins have proven benefits and are generally well-tolerated, but there are some concerns about side effects. The most reported side effect of statins is muscle pain.
Other possible side effects are uncommon but may include:
- increased blood sugar
- possible effect on memory
- liver injury
Statins come in pill form and are only available by prescription. Your doctor will
- have ASCVD (history of heart attack, stroke, peripheral vascular disease)
- have severely elevated cholesterol, such as LDL greater than 190 mg/dL
- are otherwise at high risk of atherosclerotic events
Some statins are considered “high intensity,” meaning they have the greatest observed lipid-lowering effect. These are rosuvastatin and atorvastatin. Other statins Food and Drug Administration (FDA) approved in the U.S.
- simvastatin
- pitavastatin
- fluvastatin
- lovastatin
- pravastatin
Due to decreased clearance of certain drugs in people with kidney disease, doses may need to be adjusted.
If you have kidney failure and heart disease, the benefits of treatment with statin therapy may outweigh the risks.
However, the research on statin use and the safety of people with kidney failure or kidney disease is mixed.
Talk with your doctor about your treatment plan, which depends on your stage of CKD. You and your doctor can decide if a statin is right for you.
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