Rosuvastatin (Crestor) Use in Chronic Kidney Disease
For patients with chronic kidney disease, rosuvastatin is recommended with a maximum dose of 10 mg daily in severe renal impairment (CrCl <30 mL/min/1.73 m²), while no dosage adjustment is necessary for mild to moderate renal impairment. 1, 2
Dosing Recommendations Based on Renal Function
- In patients with severe renal impairment (CrCl <30 mL/min/1.73 m²) not on hemodialysis, start with 5 mg once daily and do not exceed 10 mg once daily 1, 2
- No dosage adjustment is necessary for patients with mild to moderate renal impairment, with standard dosing range of 5-40 mg daily 1, 2
- Asian patients should initiate rosuvastatin at 5 mg once daily due to increased plasma concentrations, regardless of renal function 2
Indications for Statin Therapy in CKD
- For adults ≥50 years with eGFR <60 mL/min/1.73 m² (CKD G3a-G5) not on dialysis or transplantation, statin or statin/ezetimibe combination is strongly recommended (1A) 3, 4
- For adults ≥50 years with CKD and eGFR ≥60 mL/min/1.73 m² (CKD G1-G2), statin monotherapy is recommended (1B) 3, 4
- For adults 18-49 years with CKD, statin therapy is suggested for those with at least one of: coronary disease, diabetes mellitus, prior ischemic stroke, or estimated 10-year cardiovascular risk >10% (2A) 3, 4
Benefits of Rosuvastatin in CKD
- Rosuvastatin effectively reduces total cholesterol, LDL-C, triglycerides, and non-HDL-C levels in CKD patients 5
- Studies suggest rosuvastatin may have renoprotective effects, including reduction in albuminuria and serum cystatin C levels 5, 6
- In the JUPITER trial, rosuvastatin reduced first cardiovascular events by 45% and all-cause mortality by 44% in patients with moderate CKD 7
- Some evidence suggests rosuvastatin may arrest the progression of renal disease in long-term treatment 8
Monitoring and Precautions
- Assess LDL-C when clinically appropriate, as early as 4 weeks after initiating rosuvastatin and adjust dosage if necessary 2
- Risk factors for myopathy with rosuvastatin include age ≥65 years, uncontrolled hypothyroidism, renal impairment, and concomitant use with certain drugs 2
- Monitor renal function periodically during treatment, as improvements in estimated GFR have been observed with rosuvastatin therapy 8, 6
- Choose statin regimens that maximize absolute reduction in LDL cholesterol to achieve largest treatment benefits 3, 4
Drug Interactions in CKD Patients
- Avoid concomitant use of rosuvastatin with cyclosporine or gemfibrozil 2
- When rosuvastatin must be used with cyclosporine, do not exceed 5 mg once daily 2
- When taking rosuvastatin with an aluminum and magnesium hydroxide combination antacid, administer rosuvastatin at least 2 hours before the antacid 2
- Multiple other medications require rosuvastatin dose limitations (10-20 mg maximum) including certain antiviral medications 2
Common Pitfalls and Caveats
- Failure to adjust rosuvastatin dosage in severe renal impairment can increase risk of myopathy and rhabdomyolysis 2
- Asian patients are at higher risk for myopathy and require lower starting doses 2
- Drug dosing errors are common in patients with renal impairment and can cause adverse effects 9
- Consider complementing statin therapy with a plant-based "Mediterranean-style" diet to further reduce cardiovascular risk 3