A widely used cholesterol medicine may carry a small but important risk for the kidneys, according to a large study led by researchers at Johns Hopkins University.
The research focused on rosuvastatin, a statin drug commonly used to lower “bad” LDL cholesterol and reduce the chance of heart attacks and strokes.
Statins are among the most commonly prescribed medicines in the world. They work mainly by reducing the amount of cholesterol made by the liver, which helps slow the buildup of fatty material inside blood vessels and protects the heart over time.
Rosuvastatin is a powerful statin and is available under brand names as well as in cheaper generic forms. However, concerns about its effects on the kidneys are not completely new, because early studies carried out before the drug was approved found blood or protein in the urine of some people taking it.
Blood in the urine is called hematuria, while protein in the urine is called proteinuria. Both can have many causes, but they can also be signs that the kidneys are under stress or are not filtering the blood as well as they should.
To better understand the possible risk, the researchers studied electronic health records collected between 2011 and 2019. They compared more than 150,000 people who had started taking rosuvastatin with nearly 800,000 people who had started taking another widely used cholesterol drug, atorvastatin.
The patients were followed for up to three years. Among people taking rosuvastatin, about 2.9% developed blood in their urine and about 1% developed protein in their urine during the study period.
After taking other differences between the groups into account, the researchers found that rosuvastatin users had an 8% higher risk of blood in the urine and a 17% higher risk of protein in the urine than atorvastatin users. They also had a 15% higher risk of developing kidney failure serious enough to require treatments such as dialysis or a kidney transplant.
The kidney risks appeared to rise as the dose of rosuvastatin increased. This is especially important for people who already have poor kidney function because their bodies may clear the medicine more slowly, allowing more of the drug to remain in the bloodstream.
The researchers also found a worrying prescribing pattern among people with advanced kidney disease. About 44% of these patients received rosuvastatin at doses higher than those recommended by the U.S. Food and Drug Administration for people with severely reduced kidney function.
Importantly, the study did not find that rosuvastatin provided better protection against heart problems than atorvastatin. The two medicines produced similar heart benefits, even though rosuvastatin was linked to somewhat higher rates of kidney-related problems.
The findings do not mean that people taking rosuvastatin should suddenly stop their medicine. Statins can greatly reduce the risk of heart attack and stroke, and stopping treatment without medical advice could be harmful.
Instead, the results suggest that doctors may need to pay closer attention to kidney function and rosuvastatin dose, particularly in patients who already have kidney disease.
The research was published in the Journal of the American Society of Nephrology. The study also shows why medicines need to be watched carefully after they reach the market, because rare or long-term side effects can become easier to see only after very large numbers of people have used a drug in everyday medical care.
For patients, the main message is to discuss any kidney problems and current medicines with their doctor. Doctors can then consider the dose, check kidney function when appropriate, and decide whether rosuvastatin or another statin offers the best balance between protecting the heart and reducing possible risks.
If you care about kidney health, please read studies about pesticide linked to chronic kidney disease, and this drug may prevent kidney failure in people with diabetes.
For more health information, please see recent studies about drug duo that may treat kidney failure, and results showing these vegetables may protect against kidney damage.
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