Inflammation is highly prevalent in patients with
chronic kidney disease (CKD) and is consistently associated with cardiovascular morbidity and mortality. Clinical event rates increase with declining renal function and activation of the
acute-phase response.
Statins are potent anti-inflammatory drugs that reduce the incidence of cardiovascular events. Owing to the increased prevalence of
inflammation in patients with CKD and the potent effect of
statins in individuals with elevated levels of
C-reactive protein, these drugs should be especially effective in patients with CKD. Whereas data indicate that
pravastatin may prevent loss of kidney function to a greater extent in individuals with evidence of increased
inflammation than in those who show no
inflammation, two large, randomized
statin trials in patients on
hemodialysis found no benefit of
statin therapy, neither in the whole study group nor after stratifying for
inflammation. Irrespective of
inflammation, guidelines recommend treatment of
dyslipidemia in early stages of CKD, which is supported by results from recent meta-analyses, and the Study of Heart and Renal Protection (SHARP), a large, randomized, placebo-controlled trial.