Cardiology Guidelines, Guidelines

Rosuvastatin, Kidney Risks, and a Clinical Takeaway


New research from Johns Hopkins further confirms that rosuvastatin use may increase the risk of kidney damage, especially at higher doses. 

Researchers gathered data from 152k patients taking rosuvastatin and nearly 800k on atorvastatin over eight years (3.1-year median follow-up) and found that: 

  • Users of rosuvastatin had an 8% higher risk for hematuria (blood in the urine), a 17% higher risk for proteinuria (protein in the urine), and a 15% higher risk for kidney failure requiring replacement therapy.
  • The risk for hematuria and proteinuria in patients with chronic kidney disease (CKD) increased as rosuvastatin dose increased.
  • The two groups avoided myocardial infarction and stroke to similar extents.

Clinical trials and observational studies linked rosuvastatin to signs of kidney damage when the FDA first approved the drug in 2003, which is why the FDA capped the recommended dosage for people with severe CKD at 10mg/day. 

But the Johns Hopkins researchers found that 44% of patients with advanced kidney disease were prescribed a daily dose exceeding the recommended maximum, suggesting that many clinicians are unaware of rosuvastatin’s dosing recommendations. 

The Takeaway

This study reinforces early reports that rosuvastatin may predispose individuals with advanced CKD to kidney toxicity, and reveals that some clinicians prescribe rosuvastatin at excessive doses. As you might expect, the authors suggested it may be wise to reduce the dosage or discontinue rosuvastatin for these patients.  

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