What is the moderate intensity statin dose for Chronic Kidney Disease (CKD) stage 4, characterized by Impaired Renal Function?

From the Guidelines

For patients with chronic kidney disease stage 4 (CKD 4), moderate-intensity statin therapy is generally recommended to reduce cardiovascular risk. The most recent and highest quality study 1 supports the use of statins in CKD patients, with a recommendation for moderate-intensity statin therapy for primary prevention of atherosclerotic cardiovascular disease (ASCVD). Some key points to consider when prescribing statins for CKD 4 patients include:

• Appropriate moderate-intensity statin options include atorvastatin 10-20 mg daily, rosuvastatin 5-10 mg daily, simvastatin 20-40 mg daily, or pravastatin 40-80 mg daily.
• Atorvastatin and rosuvastatin are often preferred in advanced CKD because they have less renal clearance.
• Dose adjustments are important in CKD 4 to minimize adverse effects while maintaining efficacy, with rosuvastatin generally not exceeding 10 mg daily in severe CKD.
• Statin therapy in CKD 4 aims to reduce cardiovascular risk, rather than targeting specific LDL levels, as the evidence for mortality benefit decreases somewhat in very advanced kidney disease.
• Patients should be monitored for muscle symptoms, liver function abnormalities, and potential drug interactions, particularly with medications commonly used in CKD such as certain immunosuppressants, antifungals, and calcium channel blockers, as suggested by previous studies 1.

From the FDA Drug Label

1. 5 Recommended Dosage in Patients with Renal Impairment

In patients with severe renal impairment (CL crless than 30 mL/min/1.73 m 2) not on hemodialysis, the recommended starting dosage is 5 mg once daily and should not exceed 10 mg once daily [see Warnings and Precautions (5.1)and Use in Specific Populations (8. 6)] . There are no dosage adjustment recommendations for patients with mild and moderate renal impairment.

For CKD 4, which is considered severe renal impairment, the recommended dosage of rosuvastatin is 5-10 mg once daily. This can be considered a moderate intensity statin dose.

• The dose should not exceed 10 mg once daily.
• Moderate intensity statin therapy is generally defined as a dose that lowers LDL-C by 30-50%.
• For rosuvastatin, a dose of 5-10 mg once daily is expected to achieve this level of LDL-C reduction. 2

From the Research

Statin Dosage for CKD 4 Patients

• The ideal statin dosage for patients with chronic kidney disease (CKD) stage 4 is not explicitly stated in the provided studies, but some insights can be gathered from the available evidence.
• A study published in 2020 3 found that pravastatin 40mg showed a significantly lower patient mortality rate compared to placebos, and also demonstrated a significant reduction in cardiac events.
• Another study from 2015 4 evaluated the efficacy and safety of high-intensity statin therapy in patients with CKD, and found that it could effectively reduce the risk of stroke, but its effects on all-cause mortality, myocardial infarction, heart failure, and renal protection remained unclear.
• A 2006 study 5 reviewed the efficacy, tolerability, and prescription guidelines of statins in CKD and renal transplant patients, and found that statins at appropriately adapted doses had the same efficacy in CKD patients as in subjects with normal kidney function, but their effectiveness in cardiovascular prevention in this population had not been demonstrated.
• A 2015 study 6 suggested that high-potency statins, such as atorvastatin or rosuvastatin, may help prevent CKD deterioration and reduce cardiovascular disease risk in patients with CKD.
• A systematic review and meta-analysis published in 2015 7 found that high-intensity statins improved the decline in estimated glomerular filtration rate (eGFR) in patients with CKD, but moderate- and low-intensity statins did not have a significant effect.

Key Findings

• Pravastatin 40mg may be an effective dosage for reducing cardiac events and mortality in CKD patients 3.
• High-intensity statin therapy may reduce the risk of stroke in CKD patients, but its effects on other outcomes are unclear 4.
• Statins at adapted doses are effective in CKD patients, but their effectiveness in cardiovascular prevention is not established 5.
• High-potency statins may help prevent CKD deterioration and reduce cardiovascular disease risk 6.
• High-intensity statins improve the decline in eGFR in CKD patients, but moderate- and low-intensity statins do not have a significant effect 7.