Pleiotropic Properties of Statins in Renal Protection Among Patients with Chronic Kidney Disease: A Review of Current Clinical Evidence
DOI:
https://doi.org/10.12775/QS.2026.64.73697Keywords
chronic kidney disease, statins, proteinuria, dyslipidemiaAbstract
Background
Chronic kidney disease (CKD) affects more than 10% of the global population and is associated with increased cardiovascular morbidity and mortality. Dyslipidemia contributes to CKD progression through inflammatory, atherosclerotic, and fibrotic mechanisms. Statins, widely used for lipid control, exhibit pleiotropic effects that may influence renal outcomes; however, their direct renoprotective role remains controversial.
Aim
To evaluate the efficacy and safety of statin therapy in patients with CKD, with particular emphasis on renal outcomes such as estimated glomerular filtration rate (eGFR) and proteinuria, and to analyze the molecular mechanisms underlying their pleiotropic effects.
Material and Methods
A literature review was conducted using PubMed, Google Scholar, ResearchGate, Embase, Scopus, and Web of Science. Relevant studies, including randomized controlled trials (PLANET I/II, SHARP, and CNODES) and meta-analyses, were selected according to predefined inclusion criteria.
Results
Statin therapy demonstrated a modest effect in slowing eGFR decline and reducing proteinuria; however, outcomes varied depending on the specific agent and dosage. Atorvastatin showed potential renoprotective effects, whereas high-dose rosuvastatin was associated with deterioration in renal function. High-intensity therapy may increase the risk of acute kidney injury and rare complications such as rhabdomyolysis, particularly in patients with CKD. Proposed molecular mechanisms include anti-inflammatory, antioxidant, and endothelial-protective effects.
Conclusions
Statins remain essential for reducing cardiovascular risk in patients with CKD; however, their renoprotective effects appear limited and are not uniform across all agents. Individualized therapy is crucial to balance cardiovascular benefits against potential renal risks. Further large-scale studies are needed to optimize treatment strategies in this population.
References
1. Are statins toxic or safe for kidney diseases? An updated mini-review study. J Nephropathol. 2020;9(4):e38. doi:10.34172/jnp.2020.38
2. SHARP Collaborative Group. Study of Heart and Renal Protection (SHARP): randomized trial to assess the effects of lowering low-density lipoprotein cholesterol among 9,438 patients with chronic kidney disease. Am Heart J. 2010;160:785–794.
3. Sandhu S, Wiebe N, Fried LF, Tonelli M. Statins for improving renal outcomes: a meta-analysis. J Am Soc Nephrol. 2006;17(7):2006–2016. doi:10.1681/ASN.2006010012
4. Kasiske BL, O’Donnell MP, Schmitz PG, Kim Y, Keane WF. Renal injury of diet-induced hypercholesterolemia in rats. Kidney Int. 1990;37:880–891.
5. Plosker GL, Lyseng-Williamson KA. Atorvastatin: a pharmacoeconomic review. Pharmacoeconomics. 2007;25:1031–1053.
6. Kalaitzidis RG, Elisaf MS. The role of statins in chronic kidney disease. Am J Nephrol. 2011;34:195–202. doi:10.1159/000330355
7. Assessment of adverse effects attributed to statin therapy: a meta-analysis. Lancet. 2026;407:689–703.
8. Palmer SC, Craig JC, Navaneethan SD, Tonelli M, Pellegrini F, Strippoli GF. Effect of statins on kidney disease outcomes. Am J Kidney Dis. 2016;67(6):881–892. doi:10.1053/j.ajkd.2016.01.016
9. de Zeeuw D, Anzalone DA, Cain VA, et al. Renal effects of atorvastatin and rosuvastatin in patients with diabetes who have progressive renal disease (PLANET I): a randomised clinical trial. Lancet Diabetes Endocrinol. 2015;3:181–190.
10. de Zeeuw D, Anzalone DA, Cain VA, et al. Prospective evaluation of proteinuria and renal function in non-diabetic patients with progressive renal disease (PLANET II). Lancet Diabetes Endocrinol. 2015;3:181–190.
11. Reddy GD, Reddy AG, Rao GS, et al. Interaction study on garlic and atorvastatin with reference to nephrotoxicity. Toxicol Int. 2010;17:90–93.
12. Perk J, Graham I, De Backer G. Prevention of cardiovascular disease: new guidelines. Heart. 2014;100:675–677.
13. Lenihan CR, Lafayette RA. High-potency statins and acute kidney injury-associated hospitalizations. Am J Kidney Dis. 2013;62:877–879.
14. Dormuth CR, Hemmelgarn BR, Paterson JM, et al. Use of high potency statins and rates of admission for acute kidney injury. BMJ. 2013;346:f880. doi:10.1136/bmj.f880
15. Naughton CA. Drug-induced nephrotoxicity. Am Fam Physician. 2008;78:743–750.
16. Bravo JJ, Novoa D, Romero R, Sánchez-Guisande D. Cerivastatin and acute kidney failure caused by rhabdomyolysis. Nefrologia. 2001;21:509.
17. KDIGO Clinical Practice Guideline for Lipid Management in CKD.
18. Rikitake Y, Liao JK. Rho GTPases, statins, and nitric oxide. Circ Res. 2005;97:1232–1235.
19. Cai J, Yu X, Zhang B, et al. Atorvastatin improves survival of implanted stem cells in renal ischemia-reperfusion injury. Am J Nephrol. 2014;39:466–475.
20. Gao P, Wu X, Shui H, Jia R. Fluvastatin inhibits high glucose-induced NF-κB activation in renal tubular epithelial cells. J Nephrol. 2013;26(2):289–296. doi:10.5301/jn.5000128
21. Zoja C, Corna D, Rottoli D, et al. Effect of combining ACE inhibitor and statin in severe experimental nephropathy. Kidney Int. 2002;61:1635–1645.
22. Yasuda G, Kuji T, Hasegawa K, et al. Safety and efficacy of fluvastatin in hyperlipidemic patients with chronic renal disease. Ren Fail. 2004;26:411–418.
23. Yim SH, Kim HJ, Ro H, et al. Benefits of statin therapy within a year after kidney transplantation. Sci Rep. 2021;11:21311. doi:10.1038/s41598-021-00612-9
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Copyright (c) 2026 Mikołaj Brzeźniak, Emiliia Fitz, Justyna Daniek, Filip Kręcina, Weronika Kaczmarek, Kacper Gil, Krzysztof Drelich, Aleksander Karbowniczek, Julia Maria Mokracka, Alicja Grabarczyk
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