The role of statins in chronic kidney disease (CKD): friend or foe?

The effects of statins in chronic kidney disease (CKD) are incompletely understood. To date, no clinical trial has provided definitive evidence that cholesterol lowering treatments reduce cardiovascular morbidity and mortality in CKD patients. Moreover, existing preclinical data suggest both a renoprotective effect of statins (highlighted by reduction in the rate of the decline of GFR and reduction of proteinuria) and a harmful effect (mainly by accelerating renal fibrosis) in the long-term management of patients with CKD. Although several post-hoc analyses and meta-analyses of large randomized clinical trials of statins in cardiovascular disease have provided important insights into their role in affecting the rate of renal function deterioration in CKD, no randomized clinical study has directly addressed this issue in CKD patients. In this review, we discuss the preclinical and clinical evidence supporting the beneficial or harmful effects of statins in CKD patients and propose specific recommendations regarding their use in this patient population.