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Atorvastatin Slows Kidney Function Drop More Than Nonstatin Antilipid Agents
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16th European AIDS Conference, October 25-27, 2017. Milan
Mark Mascolini
Kidney function measured as estimated glomerular filtration rate (eGFR) dropped significantly more slowly with atorvastatin than with nonstatin antilipid agents in a nonrandomized 12-month comparison of HIV-positive people with hyperlipidemia and chronic kidney disease (CKD) [1]. Atorvastatin also lowered "bad" low-density lipoprotein cholesterol significantly more than the other agents.
Bologna University researchers who conducted this study noted that abnormal lipids heighten risk of CKD progression, a frequent problem in people with HIV infection. Because the impact of antilipid statins on kidney function remains poorly understood, they conducted this prospective observational study.
The analysis included people on stable antiretroviral therapy (ART) for at least 12 months with a viral load below 50 copies for at least 6 months and with CKD, defined as eGFR (by CKD-EPI equation) at or below 60 mL/min for at least 3 months. The Bologna team defined hyperlipidemia as LDL cholesterol at or above 130 mg/dL or triglycerides at or above 200 mg/dL. Everyone was starting 10 or 20 mg of atorvastatin or other lipid-lowering drugs. The study excluded people with eGFR at or below 30 mL/min, total cholesterol above 300 mg/dL, or triglycerides above 1000 mg/dL.
The 24 people starting atorvastatin and the 29 starting other drugs had median ages of 56.8 and 56.4, median current CD4 counts of 554 and 579, median current ART durations 40.4 and 38.7 months, and median times with viral load below 50 copies 35.6 and 31.9 months. Respective proportions of men were 87% and 90% and of whites 83% and 76%. Similar proportions of both groups had diabetes (46% atorvastatin, 48% nonstatin), and only 8% and 10% were taking tenofovir disoproxil fumarate. In the atorvastatin and nonstatin groups, median LDL cholesterol stood at 151 and 156 mg/dL, median triglycerides at 248 and 239 mg/dL, and median hsCRP (an inflammation marker) at 0.87 and 0.75 mg/dL. Average eGFR lay between 50 and 51 mL/min in both groups. Among the 29 people taking a nonstatin antilipid agent, 10 took fenofibrate, 8 ezetimibe plus omega-3 fatty acids, 6 ezetimibe alone, and 5 omega-3 fatty acids alone.
Average triglycerides dropped by about 30 mg/dL through 12 months of follow-up in both groups. But over the same span average LDL cholesterol fell significantly more with atorvastatin than other agents (-32 versus -18 mg/dL, P < 0.001). Through 12 months hsCRP also fell significantly more with atorvastatin than other drugs (-0.44 versus -0.09 mg/dL, P = 0.017). And eGFR fell significantly less with atorvastatin than comparison drugs, indicating a slower decline in kidney function (-0.86 versus -1.52 mL/min, P < 0.001). It is hard to say whether this 12-month 0.66 mL/min difference is clinically meaningful, but further follow-up could shed more light.
Reference
1. Calza L, Colangeli V, Borderi M, et al. Atorvastatin preserves renal function in HIV-1-infected adult patients with chronic kidney disease and hyperlipidaemia. 16th European AIDS Conference. October 25-27, 2017. Milan. Abstract PE9/20.
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