Long-term effects of statin use linked to increased kidney disease, injury

During a follow-up period of approximately 6 years, use of statin therapy was associated with increased incidence of acute kidney injury and chronic kidney disease, according to new findings.

Researchers conducted a retrospective propensity-matched cohort study of adults from the San Antonio area military health care system to determine whether statin use affected kidney-related outcomes over time.

From a database of 43,438 patients, Tushar Acharya, MD, of the division of cardiology, department of internal medicine at the University of California, San Francisco, and colleagues matched 6,342 statin users with 6,342 nonusers using 82 characteristics based on demographics, comorbidities, medications and health care utilization. They also performed a second set of propensity matching of 3,351 patients who used statins for primary prevention and did not have significant comorbidities (healthy cohort), and 3,351 nonusers with similar characteristics.

The outcomes of interest were acute kidney injury, chronic kidney disease (CKD) and nephritis/nephrosis/renal sclerosis. Mean follow-up was 6.19 years (median, 6.42; interquartile range, 6.21-6.48).

Among statin users, 73.5% were taking simvastatin, mean duration of use was 4.65 years and approximately 38% were taking high-intensity statins.

In the overall cohort, statin use was associated with increased incidence of acute and unspecified renal failure (users, 8.4%; nonusers, 6.6%; OR = 1.3; 95% CI, 1.14-1.48; number needed to harm = 55), CKD (users, 13.5%; nonusers, 10.3%; OR = 1.36; 95% CI, 1.22-1.52; number needed to harm = 31) and nephritis/nephrosis/renal sclerosis (users, 2.3%; nonusers, 1.8%; OR = 1.35; 95% CI, 1.05-1.73; number needed to harm = 163), according to the researchers.

In the healthy cohort, statin use corresponded to increased incidence of CKD (users, 8.6%; nonusers, 5.8%; OR = 1.53; 95% CI, 1.27-1.85; number needed to harm = 36), but not of acute and unspecified renal failure (OR = 1.25; 95% CI, 0.98-1.59) or nephritis/nephrosis/renal sclerosis (OR = 1.39; 95% CI, 0.76-2.56).

The association was attenuated after adjustment for diseases and conditions that developed during the follow-up period, they found.

In the overall cohort, incidence of an outcome of interest was higher in those on high-intensity statins than in those on low-or-moderate intensity-statins, according to the researchers.

“These findings are cautionary and suggest that long-term effects of statins in real-life patients may differ from shorter-term effects in selected clinical trial populations,” Achaya, from the division of cardiology, department of internal medicine, University of California, San Francisco, and Fresno Medical Education Program, Fresno, California, wrote. – by Erik Swain

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