Best statin for kidney disease

In this article:

• How do statins affect people with kidney disease?
• Top recommended statins for people with kidney disease
• Statins comparison chart
• Side effects of statins in people with kidney disease
• Special considerations for people with CKD taking statins

In this article

• How do statins affect people with kidney disease?
• Top recommended statins for people with kidney disease
• Statins comparison chart
• Side effects of statins in people with kidney disease
• Special considerations for people with CKD taking statins

Most people know statins as a class of cholesterol-lowering medications that are extremely popular. As of 2019, 35% of Americans were taking a statin to help lower their cholesterol levels. Yet dropping overall low-density lipoprotein cholesterol (LDL) levels isn’t the only benefit of statins. They can also help prevent kidney damage and cardiovascular disease in people with chronic kidney disease (CKD). That said, there are some considerations people with kidney disease should consider before starting statin therapy. Here’s all the info you need about taking statins for patients with kidney disease.

How do statins affect people with kidney disease?

There are two main reasons why statins are helpful for people with kidney disease: They reduce the risk of heart disease and may help prevent kidney damage. 

The American Heart Association says that half of people with stage 4 or 5 CKD also have cardiovascular disease. And studies show that the cardiovascular mortality rate is 58%–71% for people with CKD, compared to 22%–27.5% for people with normal renal function. So statins, which lower the risk of cardiovascular issues, are important for these patients. 

Statins help prevent the buildup of LDL-C in the blood vessels, and that includes vessels feeding the kidneys. Also, a 2021 study showed statin use helps slow kidney disease progression by reducing urinary albumin and protein excretion and increasing creatinine clearance. “They also provide additional benefits, such as reducing inflammation, offering antioxidant protection against cell damage, improving blood flow, and slowing the buildup of plaque and hardening of the arteries,” says Raeeda Gheewala, MD, founder and CEO of Sports Nephrology.

“In patients with end-stage kidney failure already on dialysis, evidence supporting the initiation of statins is less robust; however, continuing statin therapy is reasonable if it is well tolerated,” Dr. Gheewala adds. “An individualized approach is essential, and this is where the art of medicine truly comes into play.”

But there are downsides to statin use, too. While statins typically help protect the kidneys, research from 2016 showed that long-term statin use might actually increase the risk of acute kidney injury for some people. Additionally, CKD patients who take statins may have an increased risk of myopathy—including muscle pain and muscle breakdown. One study showed an elevated risk of rhabdomyolysis, a particular type of myopathy where components of broken-down muscle are released into the bloodstream.  

This is why healthcare providers monitor kidney function and overall health routinely when you’re taking a statin for CKD. 

Top recommended statins for people with kidney disease

There are many different statins on the market, which might leave you wondering which one is best for kidney disease. Ultimately, that’s your healthcare provider’s call to make, since they know your medical condition, history, other medicines, and overall health. But here are a few of the most commonly prescribed statins for people with kidney disease. 

Lipitor (atorvastatin)

“​​Atorvastatin is often the first choice in my patients with mild-to-moderate CKD (stages 1–3) because it typically does not require dose adjustment in these stages and has extensive clinical trial data supporting its safety and efficacy,” says Jason B. Carter, MD, a medical adviser at Aeroflow Urology. “Also, its lipophilic nature allows for broad tissue distribution, contributing to its LDL-lowering effects.”

A study from the Journal of the American Heart Association found that atorvastatin both improved kidney function and decreased cardiovascular risk. It’s also excreted through the liver, not the kidneys, so it avoids making the kidneys work harder. And dialysis doesn’t remove it, so it doesn’t require different doses for dialysis and non-dialysis patients. All that combined makes it a fairly safe and effective option for CKD patients. 

Crestor (rosuvastatin)

Like Lescol and Lipitor, Crestor has shown efficacy in reducing the risk of major adverse cardiovascular events (like a heart attack) for people with kidney disease. However, it also presents a higher risk of kidney-related side effects, including kidney damage at higher doses. Plus, people who have severe renal impairment might need a dose adjustment. “In patients with advanced CKD (stages 4-5), lower starting doses are recommended to minimize the risk of side effects such as statin-associated myopathy due to reduced renal clearance,” Dr. Carter says. 

Pravachol (Pravastatin)

“Pravastatin may be selected for patients at higher risk of drug–drug interactions or those with a history of muscle-related adverse effects,” Dr. Carter says. “It is more hydrophilic than other statins, which limits its penetration into non-hepatic tissues, including muscle.” But while it’s a good option for patients on multiple drugs, it’s a lower intensity statin, so it might not lower LDL quite as much as Lipitor or Crestor. 

Lescol (fluvastatin)

Lescol and Lipitor work the same way—by inhibiting a liver enzyme that helps make cholesterol—so it makes sense that both are effective for kidney disease. In fact, a 2019 study found that fluvastatin might perform even better than atorvastatin in some metrics. It’s also filtered out by the liver, not the kidneys, and it doesn’t require dose adjustments based on the severity of the renal impairment. On top of that, it has fewer serious drug interactions than Lipitor, so it might be safer for some people. 

Statins comparison chart
Name	Pros	Cons	Cost*	Savings
Lipitor (atorvastatin)	Moderate-to-high intensity No dose adjustment Not excreted through kidneys	Greater risk of myalgia More drug interactions	$8 for 30, 40 mg tablets of generic atorvastatin	Get coupon
Crestor (rosuvastatin)	High intensity Reduced risk of cardiovascular events	Higher risk of kidney-related side effects Dose adjustment necessary	$8 for 30, 10 mg tablets of generic rosuvastatin	Get coupon
Pravachol (pravastatin)	Lower risk of myalgia Fewer drug interactions	Low intensity	$17 for 90, 40 mg tablets of generic pravastatin	Get coupon
Lescol (fluvastatin)	Lower risk of side effects Fewer drug interactions	Low intensity	$45 for 30, 20 mg tablets of generic fluvastatin	Get coupon

*Average cost at time of publication. Drug prices fluctuate and vary by pharmacy and location. 

Side effects of statins in people with kidney disease

Like any other medication, statins may cause side effects. Some of the most common include:

• Muscle aches (myalgia)
• High blood sugar (hyperglycemia)
• Increased liver enzymes (transaminitis)
• Digestive issues
• Headaches
• Memory loss
• Confusion 

The specific side effects vary with the specific individual and statin medication. Some people might not experience any adverse effects at all. This side effect profile is similar for people with kidney issues. High doses or long-term use of statins, however, may cause kidney injury in some patients, and there’s a higher risk of interactions, since the kidneys can’t eliminate drugs as efficiently. 

It’s important to see a healthcare provider if you experience any side effects. Additionally, seek medical advice if you experience symptoms of rhabdomyolysis—unexplained muscle pain/weakness or dark urine—or liver dysfunction, like jaundice or dark urine. Any indication of kidney issues, like significant changes in urinary output, should also be addressed by a healthcare provider. 

Special considerations for people with CKD taking statins

Aside from side effects and other precautions, there are some considerations healthcare providers and patients will need to assess before prescribing statins. 

Depending on which statin you’re taking, dosage can be particularly important. Some statins will require different doses based on the stage of kidney disease you’re in, or whether you’re on dialysis. Some statins aren’t recommended at all for late-stage kidney disease, kidney failure, or dialysis patients. 

“​​Dose adjustments may be necessary based on CKD stage estimated by glomerular filtration rate (eGFR),” Dr. Carter says. “Since CKD patients may have a higher baseline risk of statin-induced myopathy, especially at higher doses or when interacting medications are present, I counsel my patients to promptly report muscle pain, weakness, or dark urine.”

In the same vein, statins that are metabolized by the liver are preferable to those excreted through the kidneys. When the kidneys function inefficiently, they have more trouble completely eliminating renally excreted drugs. Since statins can cause muscle damage and affect blood sugar levels—potentially leading to new-onset diabetes mellitus—healthcare providers will also likely want to monitor those levels regularly. 

Most importantly, inform a healthcare professional about any changes in your health or side effects you experience during statin treatment. That way, they can address any issues promptly and adjust treatment.