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Statin Therapy Did Not Affect Kidney Function in Older Adults With and Without CKD
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Key Takeaways
- Statin therapy showed no effect on kidney function in older adults, regardless of CKD status, based on eGFR and UACR assessments.
- The ASPREE trial involved 18,056 participants aged 65 or older, focusing on primary prevention and kidney-related outcomes.
Statin use is not associated with a change in incident chronic kidney disease (CKD) and estimated glomerular filtration rate in adult patients aged 65 and older.
Research published in Journal of the American Geriatrics Society demonstrates that in patients with and without chronic kidney disease (CKD), statin therapy did not have an effect on kidney function. This suggests that health care professionals’ decision on statin use in this patient population may be guided by other factors other than kidney health.1
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This study was part of a larger randomized, double-blind, placebo-controlled, primary prevention clinical trial, ASPREE (NCT01038583)2, which assessed the administration of 100 mg of aspirin daily in a population of health older adults. The primary outcome of the whole trial was the length of survival free of dementia and disability, and the secondary outcomes included major health issues related to aging, such as CKD or other kidney-related diseases. These end points were assessed every 6 months.2
Because the effect of statin therapy on kidney function among older adults was unclear, the investigators examined potential associations between statins and the changes in estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (UACR) in this population. The analysis included a total of 18,056 patients 65 years or older with or without CKD at baseline and without no prior cardiovascular events, major physical disability, or initial dementia. Only 21.1% (n = 3802) of patients enrolled had CKD at baseline.1
For this analysis, patients were randomly assigned to receive either 100 mg of enteric-coated aspirin once per day or a matching placebo. The outcomes specific to this study were eGFR and UACR, and linear mixed-effects models were utilized to estimate the associations of baseline statin use versus no use with eGFR and UACR changes over time. Additionally, inverse-probability of treatment-weighting technique was used for all analyses to address any confounding by indication.1,2
The findings indicated that statin use was not associated with a change in eGFR, UACR, or incident CKD in patients with or without CKD at baseline (p > 0.05 for all associations). The authors observed that those with CKD who were taking a statin at baseline were more likely to be female, have a higher body mass index, have a lower eGFR, be taking a protein pump inhibitor or other lipid agent, have polypharmacy, hypertension, and diabetes compared with those not taking one.1
No significant difference was observed in the association with rosuvastatin use and eGFR change or UACR change in participants with and without CKD at baseline when compared to other statins, according to the authors. Rosuvastatin use was also not associated with incident CKD in participants who did not have CKD at baseline when compared to other individual statin agents. Additionally, there was no difference in incident CKD seen with use of rosuvastatin compared with other statins in a secondary analysis. Subgroup analyses also showed that there were no significant interactions between statin use and age, sex, diabetes, country, and frailty status on any of the study outcomes.1
“While older adults are at greatest risk of cardiovascular events and kidney function decline, they are also the population at highest risk of adverse effects from medications; therefore, evidence demonstrating no negative association between statin use and kidney function provides an equally important message to one of kidney benefit,” the authors wrote in a news release.3
