What is the recommended dosage of rosuvastatin (statin medication) for patients with impaired renal function?

Rosuvastatin Dosing in Renal Impairment

For patients with severe renal impairment (creatinine clearance <30 mL/min/1.73 m²), start rosuvastatin at 5 mg once daily and do not exceed 10 mg daily. 1

Standard Dosing by Renal Function

Mild to Moderate Renal Impairment

• No dosage adjustment is necessary for patients with mild to moderate kidney disease 2, 1
• The standard dosing range of 5-40 mg once daily can be used safely 1

Severe Renal Impairment (CrCl <30 mL/min/1.73 m²)

• Initiate at 5 mg once daily 2, 3, 1
• Maximum dose: 10 mg once daily 2, 3, 1
• This applies to patients not on hemodialysis 2, 3

End-Stage Renal Disease on Hemodialysis

• Apply the same dosing restrictions as severe renal impairment: start at 5 mg daily, maximum 10 mg daily 3
• The KDOQI guidelines recommend similar considerations for hemodialysis patients as those with CrCl <30 mL/min/1.73 m² 3
• Important caveat: The AURORA trial showed no significant cardiovascular benefit with rosuvastatin 10 mg daily in hemodialysis patients compared to placebo, leading to recommendations for cautious use 3
• KDIGO guidelines recommend against initiating statin therapy in patients already on dialysis, but suggest continuing if already established 3

Additional Dosing Considerations

Asian Patients with Renal Impairment

• Start at 5 mg once daily due to increased rosuvastatin plasma concentrations in Asian populations 1
• Exercise particular caution when considering doses above 20 mg daily 1

Drug Interactions Requiring Dose Reduction

When rosuvastatin is used in patients with renal impairment who are also taking interacting medications, apply the more restrictive dosing limit:

• Cyclosporine: Do not exceed 5 mg once daily 1
• Teriflunomide, enasidenib, capmatinib: Do not exceed 10 mg once daily 1
• Gemfibrozil: Avoid concomitant use; if necessary, start at 5 mg and do not exceed 10 mg once daily 1
• Protease inhibitors (atazanavir/ritonavir, lopinavir/ritonavir): Start at 5 mg, do not exceed 10 mg once daily 1

Clinical Context for CKD Patients

When to Use Statins in CKD

• For adults ≥50 years with eGFR <60 mL/min/1.73 m²: Statin or statin/ezetimibe combination is recommended 4
• For adults 18-49 years with CKD: Consider statin therapy if coronary disease, diabetes, prior ischemic stroke, or 10-year cardiovascular risk >10% 4

Intensity Selection in CKD

• Moderate-intensity rosuvastatin (5-10 mg) lowers LDL-C by 30-50% 2, 5
• High-intensity rosuvastatin (20-40 mg) lowers LDL-C by ≥50% 2, 5
• In severe renal impairment, the 10 mg maximum effectively limits patients to moderate-intensity therapy 2, 1

Common Pitfalls to Avoid

• Do not use high-intensity doses (20-40 mg) in severe renal impairment, as this increases risk of myopathy and other adverse effects 2, 1
• Do not forget to assess for drug interactions before prescribing, particularly with immunosuppressants and antivirals common in CKD patients 1
• Do not initiate statins in dialysis patients unless they were already on therapy before starting dialysis, given lack of proven benefit 3
• Monitor for proteinuria and hematuria, though these are mostly transient at recommended doses 6