Abstract 9593: Effects of Atorvastatin and Rosuvastatin on Renal Function: A Meta-analysis

Abstract

Objective: To compare the effects of Atorvastatin (A) and Rosuvastatin (R) on glomerular filtration rate (GFR) and new onset proteinuria in patients at high cardiovascular risk. Methods: Randomized trials on A or R treatments reporting clinical end-points were included in the meta-analysis. Influence of treatments on GFR and new onset proteinuria was assessed. Results: 23 trials enrolling 29,147 participants were included. A significant reduction in GFR was detected in placebo-treated compared to statin-treated patients (standard mean difference [SMD]:0.056, 95% confidence interval [CI]:0.028 to 0.083, p<0.01). In particular, a significant reduction in GFR was detected in placebo compared to either R-treated (SMD:0.052, CI:0.022 to 0.081, p=0.001) or A-treated patients (SMD:0.084, CI:0.008 to 0.161, p=0.031). No significant difference in GFR was detected in 5 head-to-head studies comparing A to R (SMD: 0.043, CI:-0.041 to 0.126, p=0.319). In 9 studies comparing A to R, R treatment significantly increased the risk of proteinuria when compared to A (odds ratio [OR]:0.656, CI:0.440 to 0.977, p=0.038, heterogeneity p=0.026), but this effect was no longer significant when studies using highest therapeutic doses of R (40 mg/daily) were excluded from analysis, abolishing significant heterogeneity (OR:1.505, CI:0.827 to 2.739, p=0.181). Additionally, when trials comparing highest doses of A (80 mg/daily) and R (40 mg/daily) were analyzed, both A 80 mg and R 40 mg reduced GFR; but GFR tended to be significantly less reduced by A compared to R (SMD: 0.109, CI: -0.001 to 0.220, p=0.051). Finally in 7 trials enrolling only patients with chronic kidney disease (but not on dialysis), statin treatment (by either A or R) led to significant improvement in GFR compared to placebo (SMD:0.213, CI:0.043 to 0.382, p<0.01). However, GFR was improved by A (SMD:0.246, CI:0.024 to 0.468, p=0.030), but it was not significantly changed by R treatment (SMD: 0.166, CI: -0.097 to 0.429, p=0.216). Conclusions: A and R show similar reno-protective effects in patients at high cardiovascular risk, with comparable rates of new onset proteinuria when commonly used doses are considered. In patients with chronic kidney disease, no further deterioration of GFR is observed.