Potential benefit of statin therapy for dyslipidemia with chronic kidney disease: Fluvastatin Renal Evaluation Trial (FRET)

Abstract

Background: Dyslipidemia is a common complication of chronic kidney disease (CKD) and contributes to cardiovascular morbidity and mortality of CKD patients. Aim: The aim of the present study was to determine whether fluvastatin, which is mostly characterized by its pleiotropic anti-oxidant effects, has renoprotective effects in dyslipidemic patients with CKD. Methods: In 43 dyslipidemic patients with CKD taking fluvastatin 10 mg/day, 20 mg/day or 30 mg/day, renal functions as well as lipid profiles were assessed. Results: After 3 months of treatment with fluvastatin, LDL-cholesterol level significantly decreased. Serum creatinine level, estimated glomerular filtration rate (eGFR), urinary albumin excretion (UAE), urinary livertype fatty acid binding protein (L-FABP) level and urinary 8-hydroxydeoxyguanosine (8-OHdG) level did not change in overall patients. However, in patients with microalbuminuria (baseline UAE≥30 mg/g·creatinine; n=23), the UAE significantly decreased [2.43±0.67 to 1.98±0.80 log(mg/g·creatinine), p=0.01]. In patients with high L-FABP group (baseline L-FABP≥11 μg/g·creatinine; n=18), the urinary L-FABP level was significantly decreased (1.52±0.45 to 1.26±0.43 μg/g·creatinine, p<0.01). In the limited 23 patients with microalbuminuria, the L-FABP level was significantly decreased [1.20±0.62 to 1.03±0.49 log(μg/g·creatinine), p= 0.042], although the LDL-cholesterol level (139±28 to 129±23 mg/dL, p=0.08) only showed a tendency to decrease. The 8-OHdG level also was significantly decreased (13.6±9.6 to 9.8±3.8 ng/g·creatinine, p=0.043). In the overall patients, changes in the values for UAE and urinary L-FABP were not correlated with the changes in LDL-levels. Conclusion: Fluvastatin reduces both UAE and the urinary L-FABP level, and thus, has renoprotective effects, independent of its lipid lowering effects in dyslipidemic patients with CKD. © 2011 The Japanese Society of Internal Medicine.