Studies have shown that statins can protect against fatal cardiac events, which has led to their widespread use. But getting people to take drugs has been hard because their side effects are seen as a big turnoff.

With statins, muscular problems are common, but some cases progress to the point of muscle fibre death and even kidney failure.

Statins can effectively control high cholesterol, and many people use rosuvastatin, one member of this medicine class.

Rosuvastatin, particularly at higher doses, may have negative effects on the kidneys, according to a new study published today in JASN.

At the time of its approval by the US Food and Drug Administration, reports tied rosuvastatin to symptoms of kidney damage—hematuria (blood in the urine) and proteinuria (protein in the urine), but insufficient post-marketing surveillance existed to assess real-world risk.

In order to conduct their investigation, Jung-Im Shin, MD, PhD (Johns Hopkins Bloomberg School of Public Health) and her team examined electronic health record data for 152,101 new rosuvastatin users and 795,799 new atorvastatin users between 2011 and 2019.

The team discovered hematuria in 2.9 percent of patients over a median follow-up of 3.1 years and proteinuria in 1.0 percent of patients.

Compared to atorvastatin, rosuvastatin was linked to an 8 percent higher risk of blood in the urine, a 17 percent higher risk of protein in the urine, and a 15 percent higher risk of kidney failure that needed replacement therapy like dialysis or a transplant.

A larger dose of rosuvastatin carried a higher risk of proteinuria and hematuria. Additionally, 44 percent of patients with advanced kidney disease were provided with a greater dose of rosuvastatin than is recommended by the US Food and Drug Administration for people with poor kidney function.

“We observed a higher risk of hematuria, proteinuria, as well as kidney failure with rosuvastatin use and similar cardiovascular benefits between the rosuvastatin and atorvastatin groups,” notes Dr. Shin.

“Because rosuvastatin may cause proteinuria and hematuria, especially with high dose,” according to the author, “high dose rosuvastatin may not merit the risk—even if small—particularly for patients with advanced kidney disease.”

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