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Lowering cholesterol in chronic kidney disease: is it safe and effective?

The value of cholesterol lowering in preventing cardiovascular disease has now been established in patients with chronic kidney disease (CKD), who are intrinsically at high cardiovascular risk. While data from completed studies has clearly demonstrated substantive benefit of statins in early CKD, the effects in end-stage CKD remain controversial. Recent studies have also suggested that the effects of different statins on the kidney may be heterogeneous, and the safety of high-dose statins in this population remains uncertain. Communications from regulators such as the US Food and Drug Administration concerning potential side effects of statin therapy (particularly memory loss and the risk of diabetes) have created debate in the medical literature and unrest in the public mind about the value of long-term statin therapy for vulnerable patient populations. The evaluation of risks and benefits for this class of agents is critically dependent on baseline risk. This article will review current evidence for the benefits and risks of statin therapy for kidney and cardiovascular disease progression in the CKD population.